中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

改良心内/心外管道全腔静脉肺动脉连接治疗复杂先天性心脏病

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目的 探讨心内/心外管道全腔静脉-肺动脉连接手术的外科治疗经验。 方法 回顾性分析 2008 年 1 月至 2015 年 12 月 47 例复杂先天性心脏病患者的临床资料。其中男 29 例、女 18 例,年龄 7(4~9)岁;体质量 22(14~38)kg。经心脏超声心动图及心脏造影明确诊断,需行全腔静脉-肺动脉连接手术(TCPC)手术。 结果 全组无早期死亡。术后平均肺动脉压 16(12~20) mm Hg,呼吸机辅助通气时间 14(7~97)h。主要并发症为顽固性胸腔渗出 7 例、低心排血量综合征 3 例、反复室上性心动过速 1 例,经治疗后均好转。出院前末梢经皮血氧饱和度 85%~96%(92.6%±3.3%),心脏彩超显示人工血管血流通畅,压差为 0~2 mm Hg。患者随访 1~7 年,失访 3 例,1 例肠道营养丢失、反复胸膜腔积液,治疗无效,术后 4 年死亡;4 例反复胸腔积液经治疗后好转;1 例术后发生室上性心动过速者,术后 1 年内反复发作,长期服用可达龙,目前已经停药 28 个月,未复发。生存患者心功能Ⅰ~Ⅱ级,活动耐量良好。 结论 改良的心内/心外管道 TCPC 兼容了心内隧道、心外管道 TCPC 两者的优点,手术操作简便,用于复杂先天性心脏病的生理性矫治,近期、中期治疗效果满意。

Objective To investigate the surgery experience of modified intra/extracardiac conduit total cavopulmonary connection (TCPC). Methods We retrospectively analyzed clinical data of 47 patients of complex congenital heart disease undergoing intra/extracardiac conduit total cavopulmonary connection in our hospital between January 2008 and December 2015. There were 29 males and 18 females with a median age of 7 years (range 4 to 9 years) and median body weight of 22 kg (range 14 to 38 kg). The heart echocardiography and cardiac imaging confirmed diagnosis suitable for TCPC surgery. Results There was no early death in the whole group. The mean pulmonary arterial pressure was 16 (12–20) mm Hg and the ventilation time was 14 (7–97) h. The main complications were intractable pleural effusion in 7 patients, low cardiac output syndrome in 3 patients, repeated supraventricular tachycardia in 1 patient. All the patients recovered after treatment. At the end of discharge, the percutaneous oxygen saturation was 85%–96% (92.6%±3.3%). The echocardiography showed the conduit pressure was 0–2 mm Hg. Patients were followed up for 1 to 7 years. Three patients were lost. One patient had intestinal nutrition loss, receving repeated pleural effusion, the treatment was ineffective, died after 4 years. Four patients of repeated pleural effusion improved after treatment. One patient repeated attacks supraventricular tachycardia within 1 year, controlled by amiodaronum, already stopped about 28 months. No recurrence occurred. All survivors were in New York Heart Association (NYHA) functional class Ⅰ or Ⅱ, with good activity tolerance. Conclusion The modified intra/extracardiac conduit TCPC combines the advantages of both the lateral tunnel and the extracardiac conduit. The operation is simple, used in the treatment of complex congenital heart disease. The short-term and mid-term results are encouraging.

关键词: 复杂先天性心脏病; 全腔静脉-肺动脉连接手术; 心内/心外管道

Key words: Complex congenital heart disease; total cavopulmonary connection; intra/extracardiac conduit

引用本文: 黄健兵, 梅举, 张俊文, 张韫佼, 张丽, 丁芳宝. 改良心内/心外管道全腔静脉肺动脉连接治疗复杂先天性心脏病. 中国胸心血管外科临床杂志, 2018, 25(4): 303-306. doi: 10.7507/1007-4848.201703052 复制

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