婴儿完全型肺静脉畸形引流的手术治疗

Correction of total anomalous pulmonary venous connection in infant less than one year old

目的 探讨婴儿完全型肺静脉畸形引流早期手术治疗的意义。方法 一岁以内完全型肺静脉畸形引流婴儿 2 8例 (男 2 3例 ,女 5例 )。手术矫治 2 4例 ,平均月龄 6 0 4± 3 34,平均体重为5 74kg± 1 2 2kg ;心上型 10例 (41 6 7% ) ,心内型 11例 (45 83% ) ,心下型 1例 (4 17% ) ,混合型 2例(8 33 % )。 4例患儿术前准备过程中缺氧发作致循环呼吸衰竭死亡 ,未能实施矫治手术 ,其余患儿均在全麻、低温、体外循环下行完全型肺静脉畸形引流矫治术 ,其中急诊手术 4例。结果 术后早期(30d)死亡 3例 (12 5 % )。心内型 1例因术后出血时间较长 ,二次开胸探查较晚致循环衰竭死亡 ;心上型 1例因术中吻合口渗血、心功能低下死亡 ;混合型 1例因术毕左房压高、不复跳 ,最终循环衰竭死亡。 4例急诊手术婴儿均存活。术后主要并发症为室上性心律失常 (10例 )。结论 婴儿完全型肺静脉畸形引流早期手术疗效满意 ,远期结果有待观察。左房、左室及房间隔缺损大小对手术效果无明显影响 ,必要时可行急诊手术。但心律失常发生率较高。

Objective To evcaluate the effects of early correction for total anomalous pulmonary venous connection (TAPVC) in infant under one. Methods Twenty-eight infants less than one year old with TAPVC were admitted and prepared to be treated surgically from July 1995 to August 2001. Total correction was performed on 24 cases, 20 males and 4 famales, aged 6.04±3.34 months, with the mean body weight of 5.74±1.22 kg, of which 10 (41.67%) being of supracardic type, 11 (45.83%) being of intracardiac type, 1 (4.17%)being of infracardiac type, and 2 (8.33%)being of mixed type. Four patients died of hypoxic attack during anteoperative preparation and failed to be operated upon. Results Three infants (12.5%) died within 30 days after operation. One case of intracardiac type died of circulatory failure because of severe postoperative bleeding and late exploratory thoracotomy. One case of supracardiac type died of cardiac sufficiency bacause of bleeding at anastomotic stoma during operation. One case of mixed type died of circulatory failure because of high pressure of left cardiac atrium. All of the 4 cases who underwent emergent operation survived. The most common complication was arrhythmia (41.67%). Conclusion The early effect of early correction for TAPVC is satisfactory and its long-term effect is to be observed. A wide anastomosis between the posterior wall of the left atrium and common pulmonary vein is more important for the supracardic type. The diameters of left atrium, left ventricle and atrial septum defect have little effect on operative results. Arrhythmia after operation has no significant increase in supracardic type through. With rather high incidence rate of arrhythmia (5/8, 62.5%), the combined left atrium incision and right atrium incision approach assures a sufficiently large incision for the supracardiac type. However, this approach is statistically different in the incidence rate of arrhythmia only between supracardiac type and intracardiac type.