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|本期目录/Table of Contents|

心外管道全腔肺动脉连接术在复杂先心病中的应用

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2013年第6期
页码:
699-701
栏目:
临床研究
出版日期:
2013-11-25

文章信息/Info

Title:
Application of total cavopulmonary connection with extracardiac conduit in treatment of complex congenital heart disease
作者:
浮志坤1; 董自超1; 谷小卫1; 裴 琳2; 杜 虹1; 姚 伟1; 张志远1
(解放军第91中心医院：1.心脏外科，2.体外循环科，河南 焦作 454003)
Author(s):
FU Zhi kun1;  DONG Zi chao1;  GU Xiao wei1;  PEI Lin2;  DU Hong1;  YAO Wei1;  ZHANG Zhi yuan1
(1.Department of Cardiac Surgery, 2.Department of Cardiopulmonary Bypass, PLA 91st Central Hospital, Jiaozuo 454003, Henan, China)
关键词:
全腔肺动脉连接术; 复杂先天性心脏病; 外科手术
Keywords:
total cavopulmonary connection;  congenital heart disease;  surgery
分类号:
R541.1
DOI:
-
文献标识码:
A
摘要:
目的:总结心外管道全腔肺动脉连接（total cavopulmonary connection,TCPC）术治疗复杂先天性心脏病的临床经验。方法:2002年1月～2011年5月，采用外管道TCPC术矫治复杂先天性心脏病47例（病种包括三尖瓣闭锁、单心室、肺动脉闭锁、右心室发育不良、右室双出口）患者，手术年龄（8±4）岁。一期手术25例，分期手术22例。结果:术后早期（术后1月）死亡4例(8%)。死亡原因：多脏器功能衰竭、心脏骤停、感染、蛋白丢失性肠病和低心排。术后早期并发症发生率为17%，主要为肺水肿3例、胸腔积液2例、心律失常1例、心包积液1例、蛋白丢失性肠病和低心排1例。术后均随访，随访时间9～87月。远期再住院率为9%（4/43），再次手术7%(3/43)。2例再次出现胸腔积液，2例因自行停服肠溶阿司匹林后出现外管道堵塞再次手术，1例于术后出现低心排死亡。其余患者恢复良好。结论:对于适应证明确的复杂先天性心脏病患者行心外管道TCPC手术治疗，近期临床效果满意。
Abstract:
AIM:To summarize the effects of total cavopulmonary connection with an extracardiac conduit in treatment of complex congenital heart disease. METHODS: Between January 2002 and May 2011, 47 patients ［mean age (7.5 ± 3.8) years］ with complex congenital heart disease underwent total cavopulmonary connection with extracardiac conduit. Diagnoses of the patients included tricuspid atresia, single ventricle, pulmonary atresia, right ventricular dysplasia and double outlet right ventricle. Onestage operation was performed in 25 patients and the other 22 patients underwent a bidirectional Glenn shunt before completion of the total cavopulmonary connection. RESULTS: There were four (8.5%) cases of early deaths (within 1 month) due to multiple organ failure, cardiac arrest, infection, proteinlosing enteropathy or low cardiac output syndrome. Early postoperative complications included pulmonary edema, pleural effusion, arrhythmias, pericardial effusion, proteinlosing enteropathy and low cardiac output. Total morbidity rate was 17% (8/47). During a followup of 9-87 months, the readmission rate was 9.3% (4/43) and reoperation rate was 6.9% (3/43). Pleural effusion recurred in two cases, reexploration was conducted in two cases for obstruction of extracardiac conduits after withdrawal of aspirin and one patient died due to postoperative low cardiac output. The other patients recovered without incident. CONCLUSIONS: Total cavopulmonary connection with extracardiac conduit achieves good shortterm results in treatment of complex congenital heart disease.

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备注/Memo

备注/Memo:
收稿日期：2013-04-12.作者简介：浮志坤，主治医师 Email：fuzhikun@126.com
更新日期/Last Update: 2013-11-20