右室双腔心的外科治疗

目的 总结右室双腔心的解剖诊断和外科治疗经验.方法 回顾性分析2001年9月-2014年6月手术治疗76例右室双腔心患者的临床资料.所有患者均在低温、浅低温体外循环下施行根治手术.58例采用三尖瓣径路＋右室流出道径路（A组）,18例采用单纯三尖瓣径路或合并肺动脉径路（B组）.比较两组术中、术后情况.结果 76例患者均顺利完成手术.术中无停机困难、大出血等情况发生.A组患者体外循环时间、术后24 h平均多巴胺用量、辅助通气时间、术后24 h引流量和右束支传导阻滞发生率均高于B组,差异均有统计学意义（P值均＜0.01）;而疏通术后收缩压差、主动脉阻断时间与B组比较,差异均无统计学意义（P值均＞0.05）.全组无一例死亡.术后并发低心排血量综合征5例,严重心律失常6例,呼吸功能衰竭1例,经对症处理后均治愈.76例均获随访,随访时间3个月～13年,平均4.26年.所有患者无死亡,心功能恢复满意.结论 熟练掌握右室双腔心的病理解剖、正确有效地疏通右心室腔是手术成功的关键;通过三尖瓣或右心室流出道均可解除右室双腔心梗阻,但三尖瓣径路可获得更好的近远期效果.

Surgical treatment of double chambered right ventricule

Objective To summarize the experience in the anatomical diagnosis and surgical treatment of double chambered right ventricule.Methods From September 2001 to June 2014,76 patients were admitted in our department.The resection was made through atrialtomy-right ventricular outflow tract incision in 58 patients （group A）,through atrialtomy in 11 patients or through atrialtomy-pulmonary arteriotomy in 7 patients （group B）.Results The 76 cases of patients were successfully completed the operation.There were no any difficulties in the termination of cardiopulmonary bypass,no bleeding and other operation condition.The cardiopulmonary bypass time,postoperative average dosage of dopamine in 24 hours,ventilation time,postoperative drainage volume in 24 hours and the incidence of right bundle branch block in group A were higher than those in group B,the differences were statistically significant （all P values 〈 0.01）.However,the dredging postoperative systolic pressure difference and aortic cross clamping time in group A had no statistically significant differences compared with those ingroup B （all P values 〉 0.05）.There were no deaths.Postoperative complications included 5 cases of low cardiac output syndrome,6 cases of severe arrhythmia,1 case of respiratory failure.They were all cured after timely and correct treatment.Follow up was extended 5 months to 13 years in the recovered patients.There were no any correlated complications.Conclusions It is critical and essential for a successful operation to perfectly comprehend double chambered right ventricule pathoanatomy,correctly identify anomalous muscle bundle and effecttively deoppilate right ventricular outflow tract.Both trans right ventricular outflow tract stenosis and transatrial approach can relief right ventricular outflow tract stenosis obstruction,but the latter seems have better early and midterm effects.