非体外循环下行上腔静脉-肺动脉双向分流术的治疗体会

Bidirectional Glenn shunt without cardiopulmonary bypass

目的 介绍非体外循环下行上腔静脉 肺动脉双向分流术 (简称双向Glenn分流术 )的体会。方法 2 0 0 0年 5月至 2 0 0 2年 7月 ,非体外循环下行双向Glenn分流术 80例。年龄 (3.2 4±1.0 9)岁 ,体重 (12 .6± 5 .0 )kg。上腔静脉与右心耳插管临时转流 ,自上腔静脉入右房口处横断上腔静脉 ,近心端缝闭 ,应用可吸收线远心端与右肺动脉行端侧吻合 ,前壁用自体心包片加宽。结果 全组患儿无手术死亡 ,术后并发症 6例 (7.5 % ) :一过性昏迷 1例 ,乳糜胸 5例。腔静脉阻断时间 (4 0±15 )min ,术前氧饱和度 74 %± 10 % ,肺动脉平均压 (12 .8± 2 .3)mmHg ;术毕氧饱和度 92 %± 4 % ,肺动脉平均压 (16 .7± 3.2 )mmHg ,呼吸机辅助时间为 (14± 9)h ,住院天数 (8± 4 )d。 结论 非体外循环下行双向Glenn分流术是一种安全、可靠的术式。对于难以解剖根治或Ⅰ期生理矫治的肺血少复杂先心病该术式是一种良好的手术方法。

Objective To review the experiences of bidirectional Glenn shunt without cardiopulmonary bypass in children with complex cyanotic congenital heart disease.Methods Eighty patients underwent bidirectional Glenn shunt without cardiopulmonary bypass between May 2000 and July 2002. The diagnosis included pulmonary atresia (14), tricuspid atresia (18), double outlet right ventricle (12), transposition of great arteries (14), single ventricular (18) ,corrected transposition of great arteries (2) and tetralogy of Fallot with endocardial cushions defect (2).The age ranged 3.24 ± 1.09 years and the weight was 12.6 ± 5.0 ?kg. Temporary bypass was established by cannulating SVC (superior vena cava ) and right auricle before transecting right SVC. The cardiac end of SVC was sutured. The cranial end was anastomosed onto right pulmonary artery via a longitudinal incision at the superior margin with running absorbable suture. The anterior wall of the anastomosis was broadened with pericardium.Results There was no operative mortality in this group. Six patients developed complications including temporary coma and chylothorax. The mean SVC cross clamping time was 40±15?min. The oxygen saturation and MAP were (74±10)% and 12.8 ± 2.3 ?mmHg before operation, and (92±4)% and 16.7 ± 3.2 ?mmHg after operation respectively. The average mechanical ventilation time was 14±9?h. The mean postoperative hospital stay was 8±4?d.Conclusion Bidirectional Glenn shunt without cardiopulmonary bypass is a safe and reliable choice for children with complex CHD who are not suitable candidates for one stage correction.