三尖瓣闭锁的外科治疗

SURGICAL TREATMENT OF TRICUSPID ATRESIA

本所从1979年1月到1991年5月手术治疗三尖瓣闭锁19例。其中Ⅰ_b型11例,6例作了右房和右室连接,2例右房到肺动脉带瓣管道以及3例因漏斗腔堵塞或年龄小而作了全腔静脉与肺动脉连接,Ⅱ_b型6例和Ⅲ_a型2例,均作了右房与肺动脉连接。早期死亡1例,晚期死亡2例,其余16例经随诊3个月到12年,心功能工级14例,Ⅱ级2例。目前公认,三尖瓣闭锁仍以应用改良Fontan手术为主,但对Ⅰ_b型合并肺动脉瓣及其瓣环狭窄或严重漏斗部狭窄或婴幼儿,可选用全腔静脉与肺动脉连接。

From January, 1979 to May, 1991, 19 patients with tricuspid atresia were operated on in our institute. Among them were 11 cases with Type Ib, of whom 6 cases received right atrial-right ventricular connection, 2 cases with atrial-pulmonary connection by valved conduit, and 3 cases, because of severe infundibular obstruction or they were too young, received total cavopul-monary connection. 6 cases with Type Ib and 2 cases with Type IIIa all received right atrio-pulmonary connection. There was one early death and two late deaths. The other 16 cases were followed up for 3 months to 12 years. In 14 surviving patients, the heart function was class J and 2 class II. At present, Fontan operation is still known as the principal method for the treatment of tricuspid atresia, however, for patients who are associated with stenosis of the pulmonary valve and its ring or severe infundibular stenosis, or who are infants, total cavopulmonary connection should be adopted.