非体外循环下行双向格林手术(附58例报道)

Bidirectional Glenn shunt without cardiopulmonary bypass

目的 总结非体外循环下行双向格林手术的体会。方法 2 0 0 0年 5月至 2 0 0 1年 9月 ,在非体外循环下行双向格林手术 5 8例。年龄 (3 5 4± 1 5 9)岁 ,体重 (13 6± 4 0 )kg。上腔静脉与右心耳插管临时转流 ,自上腔静脉入右房处横断上腔静脉 ,缝闭近心端 ,应用可吸收线端侧吻合远心端与右肺动脉 ,前壁用自体心包片加宽。结果 全组无手术死亡 ,术后并发乳糜胸 4例 ,一过性昏迷 1例。腔静脉阻断 (48± 15 )min ,术前氧饱和度 0 75± 0 0 9,肺动脉压 (12 8± 2 3)mmHg(1mmHg=0 133kPa) ;术毕氧饱和度 0 93± 0 0 5 ,肺动脉压 (16 5± 2 9)mmHg,胸腔及心包引流液 (145± 10 3)ml,呼吸机辅助 (13± 7)h ,住院 (10± 5 )d。结论 非体外循环下行双向格林手术是一种安全、可靠的术式。对于难以解剖根治或一期生理矫治的肺血少的复杂先天性心脏病 ,该术式是一种良好的手术方法。

Objective: The aim of this study is to review the experience of using bidirectional Glenn shunt without cardiopulmonary bypass(CPB). Methods: Fifty-eight patients underwent bidirectional Glenn shunt without CPB between May, 2000 and September, 2001. The age was (3.65±1.59) years and the weight was (13.6±4.0) kg. The procedure consists of establishing temporary bypass with cannulae placed in the SVC and right auricular appendage for venous drainage and transection of right SVC. The cardiac end of the SVC is overseen. The cranial end is anastomosed to a longitudinal incision in the superior margin of the right pulmonary artery with absorbable running suture. The anterior wall of the anastomosis is widened with pericardium patch. Results: There was no operative mortality. Five cases had postoperative complications including coma in 1 and chylothorax in 4. The mean SVC crossclamp time was (48±15) mins. The preoperative oxygen saturation and CVP were 0.75±0.09 and (12.8±2.3) mmHg, respectively. While the postoperative oxygen saturation and CVP were 0.93±0.05 and (16.5±2.9) mmHg, respectively. The drainage was (145±103)ml. The average mechanical ventilation time was (13±7) hrs. The mean postoperative hospital stay was (10±5) days. Conclusion: Bidirectional Glenn shunt without CPB is a safe and reliable method, for complicated congenital heart diseases children with inadequate pulmonary blood flow when anatomic and primary physiological correction are not suitable.