完全性肺静脉异位连接的外科治疗

Surgical treatment of total anomonous pulmonary venous connection

目的:探讨完全性肺静脉异位连接(total anomalous pulmonary venous connection,TAPVC)的手术方法及疗效。方法:选取5例TAPVC患者,其中1例心上型患者行左心房共同静脉吻合;1例心内型患者将房间隔缺损扩大,应用补片将异位引流的肺静脉隔至左心房;3例混合型患者中有2例垂直静脉与左心耳吻合,补片将异位引流的肺静脉共同腔隔至左心房,1例扩大房间隔缺损后行心包片补片将异位引流的肺静脉隔至左心房。结果:所有患者均痊愈并获得随访,随访时间8个月～2年,心功能基本正常。结论:TAPVC患者一旦诊断明确应及早手术,正确认识肺静脉复杂的解剖,选择适当的手术方法可获良好的治疗效果。手术治疗的关键在于肺静脉流入左心房足够宽畅,避免狭窄。

Objective:To discuss the surgical method and curative effect of total anomalous pulmonary venous connection(TAPVC)surgery.Method:Five patients with TAPVC were collected in this study.Among them,one patient with supracardiac pattern underwent left atrial common vein anastomosis,one with intracardiac pattern was corrected by enlarging the atrial septal defect and isolating the pulmonary vein with ectopic drainage to the left atrium with mesh.Other 3 cases were hybrid type,2 of them underwent the vertical vein and left atrial auricle anastomosis,1 case was corrected by isolating the pulmonary vein with ectopic drainage to the left atrium by pericardial patch after the enlargement of the atrial septal defect.Result:All five cases were recovered with normal cardiac function and followed up for 2~8 months.Conclusion:TAPVC patients should be operated as soon as possible.Surgeon should understand the pulmonary vein complex anatomy correctly and select the appropriate surgical method to obtain satisfactory therapeutic effect.The key point of surgical treatment is to provide enough space to drain the blood from the pulmonary veins into the left atrium and to avoid stenosis.