全腔静脉-肺动脉连接术的回顾与展望

Fontan手术迄今仍是治疗单心室一类复杂先天性心脏病的主要手段。Fontan手术方法从1968年问世以来有许多改进,早期应用的心房-肺动脉连接术已为全腔静脉-肺动脉连接术所取代。通过对心房内隧道和心外管道全腔静脉-肺动脉连接术的中、晚期手术疗效进行比较分析,心外管道优点更多。然而,由于缺乏右心室的泵血功能,晚期循环衰竭最终都难以避免。当Fontan循环衰竭药物治疗无效时,惟一的选择是心脏移植,但后者供体来源缺乏。目前正研究开发的,旨在＂双心室化＂单心室Fontan循环的腔-肺机械辅助装置,有很好的前景。近年来胎儿心脏病诊疗技术的进展也拓宽了治疗复杂先天性心脏病的径路,经导管扩张严重主动脉瓣狭窄防止发展为左心室发育不全综合征,以增加双心室修复的机会;或对不能根治的复杂先天性心脏病患者终止妊娠,以降低此类复杂先天性心脏病的出生率等。我们结合文献对Fontan手术的方法进行回顾和展望。

Review and Prospect of Total Cavopulmonary Connection

Fontan operation is still a main procedure for treatment of complex congenital heart disease,such as univentricular heart.Fontan procedure has undergone many revisions since its introduction in 1968.The early-applied atrium-pulmonary connection has been replaced by total cavopulmonary connection.The midterm and late results of both the intra-atrial lateral tunnel and extracardiac total cavopulmonary connections were compared and analyzed in this article. Extra-cardiac conduit is better.The Fontan circulatio...