摘要
目的总结31例完全性肺静脉异位连接(TAPVC)患者的外科治疗经验,以提高手术疗效。方法31例患者均在中度低温体外循环下行TAPVC矫治术。其中心上型16例,心内型13例,混合型2例。所有患者均合并继发孔型房间隔缺损,合并动脉导管未闭4例,肺动脉瓣狭窄1例,二尖瓣关闭不全1例,三尖瓣关闭不全15例。结果术后无早期(30 d)死亡,发生并发症8例(25.8%),其中阵发性结性心律1例,I度房室传导阻滞1例,频发性房性早搏、短阵性房性心动过速1例;肺部感染2例,肺不张1例,气胸1例,左侧膈肌麻痹并肺部感染二次插管1例,均经治疗出院。本组31例均获得随访,随访时间2.8±1.5年,随访期间1例心上型患者于术后8个月死于心力衰竭,生存的30例患者中28例(93.3%)手术效果良好,心功能基本正常,生活工作无明显受限;治疗效果较差2例,为反复发作房性心律失常,经内科治疗无效。结论TAPVC手术方式的选择依据TAPVC畸形的特点而不同,手术的关键是完全矫治,避免出现远期肺静脉梗阻和心律失常,其治疗效果满意。
Objective To summarize the experience of the surgical treatment of total anomalous pulmonary venous connection （TAPVC） in 31 cases,so as to elevate the operative effect. Methods The total corrected operation under moderate hypothermic cardiopulmonary bypass were performed in 31 cases with TAPVC. Site of drainage was supracardiac （n=16）,eardiac（n=13）and mixed（n=2）. Other accompanying congenital cardiac malformations were diagnosed such as atrial septal defect （n = 31 ）, patent ductus arteriosus （n = 4）, pulmonic stenosis （n = 1 ）, mitral regurgitation（n = 1）, tricuspid regurgitation （n = 15）, etc. Results No hospital death was observed in the early period of operation （30 d）. Complication occurred in 8 cases （25.8 % ）, such as paroxysm of nodal rhythm（n= 1）, Ⅰ ° atrial ventricular block （n = 1 ）, frequently atrial premature beats and paroxysm of auricular tachycardia （n = 1）, pulmonary infection（n=2）, atelectasis （n = 1 ）, pneumatothorax （n = 1 ）, left diaphragmatic paralysis and pulmonary infection with tracheal reintubation （n= 1）,etc. All of them discharged after active therapy. All of 31 cases was followed up, follow-up time was 2.8± 1.5 years. 30 cases were living （96. 7%） and 1 case died of heart failure 8 months after operation. 2 cases had auricular arrhythmia with a bad medical effect. 28 cases（93.3 %） had normal heart function and they could work and live normally after discharged. Conclusion Surgical procedure should be based on individual abnormality for TAPVC. Surgeons should take care not only of the stenosis of anastomotic stoma,but also of the arrhythmia after operation. Satisfied correction of the abnormality is important and the curative effect of those cases is approving.
出处
《中国胸心血管外科临床杂志》
CAS
2009年第3期188-191,共4页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
关键词
完全性肺静脉异位引流
外科治疗
疗效
Total anomalous pulmonary venous connection
Surgical treatment
Curative effect
