32例完全性肺静脉异位引流的外科治疗

目的总结完全性肺静脉异位引流的外科治疗经验。方法回顾分析我院于2002年12月～2009年7月收治的32例完全性肺静脉异位引流患者的临床资料,其中男26例,女6例,年龄16d～7岁,平均（11.5±23.0）个月,体重（3.0～14.0）kg,平均（5.6±2.60）kg;14例心上型患儿采用共干与左心房顶部吻合,14例心内型患儿采用冠状静脉窦去顶,扩大肺静脉回流至左心房通道,心包补片修补房间隔;2例心下型采用心脏上翻方法共干与左心房吻合,2例混合根据回流采用不同的方式将肺静脉引流至左心房。结果手术后早期3例死亡,心上型2例,心下型1例;1例术后出现Ⅱ度房室传导阻滞;1例出现术后再狭窄,再次手术治疗,随访1年无残余梗阻;余27例随访2个月～7年无梗阻,心功能NYHAⅠ。结论心内型及心上型TAPVC的手术纠治中取得良好的效果;心上型采用经上腔与升主动脉间隙手术路径能明显降低术后心率失常的发生;手术前明确诊断,保证吻合口通畅是手术治疗的关键。

Surgical treatment of total anomalous pulmonary venous connection in thirty-two patients

Objective To summarized the surgical treatment of total anomalous pulmonary venous connection.Methods We retrospectively analyzed clinical data of 32 patients with TAPVC from December 2002 to July 2009,included 26 male,6 female; age was 16d～7y, mean was （11.5±23.0）months; weight was （3.0～14.0）kg, mean was （5.6±2.60）kg; 14 patients with supracardiac type in which all patients received anastomoses between the rear wall of the left atrium and the common pulmonary vein; 14 patients with cardiac type who were incised the upper edge of coronary sinus, connected the common junction of pulmonary veins with the left atrium, and repaired the atrial septal defect with a pericardial patch.There were 2 patients with infracardiac type anastomoses between the left atrium and the common pulmonary vein with the heart on the turn;2 patients with mixed type treatment method depend on the pulmonary vein connection of the heart. Results There were 3 early operative death, included 2 patients with supracardiac type and 1 patient with infracardiac type.1 patient has Ⅱ degree atrioventricular block after operation; 1 patient of cardiac type with anastomotic stenosis has reoperation after 21 months later, without anastomotic stenosis at 1 year later after the second operation.27 patients were followed up from 2 months to near 7 years got fluent pulmonary vein drainage and their heart function resumed to NYHA Ⅰ.Conclusion Supracardiac and cardiac type TAPVC correction surgery achieve good results. Supracardiac anastomosis in treatment of supracardiac type TAPVC can reduce the risk of arrhythmia. Clear pre-operative diagnosis; ensure anastomotic patencies are the key to surgical treatment of TAPVC.