搏动性双向腔静脉肺动脉吻合手术的临床应用

目的　评价搏动性双向腔静脉肺动脉吻合（Gleen）手术的临床应用价值。方法　1994年6月～2000年1月，作者对41例单心室等复杂先天性心脏畸形患者，进行了搏动双向Gleen手术。男31例，女10例。平均年龄5岁±4岁（7个月～16岁），体表面积0.64m2±0.25m2（0.35～1.48m2），术前经皮测血氧饱和度为70%±11%（25%～89%），术中肺动脉测压12.5mmHg±2.7mmHg（8～17mmHg）。其中35例在低温体外循环下手术，6例在常温下完成手术。结果　1例患者术后早期死亡，3例患者出现乳糜胸。所有存活患者紫绀明显减轻，顺利出院。出院时动脉血氧饱和度为90%±4%（77%～96%）。常温手术组术后呼吸机辅助时间明显少于体外循环手术组。结论　搏动性双向Gleen手术操作较为简便，术后早期效果良好。

Clinical usefulness of pulsatile bidirectional Glenn shunt

OBJECTIVE: To evaluate the clinical usefulness of pulsatile bidirectional Glenn shunt. METHODS: Between June 1994 and January 2000, pulsatile bidirectional Glenn shunt was operated on 41 patients, 31 males and 10 females, aged 5 +/- 4 Y (7M approximately 16Y) and with the body surface area of 0.64 +/- 0.25 m(2) (0.35 approximately 1.48 m(2)), 35 operations being performed under hypothermia with cardiopulmonary bypass, and the other 6 operations being performed at ordinary temperature without cardiopulmonary bypass. The SaO(2) before operation was 70% +/- 11% (25% approximately 89%). The pulmonary pressure measured during operation was 12.5 mm Hg +/- 2.7 mm Hg (8 approximately 17 mm Hg). RESULTS: One patient died in the early postoperative period, three got chylothorax, and the others made uneventful recovery. This operation provides excellent early palliation of cyanosis. The average SaO(2) was 90% +/- 4% (77% approximately 96%) on discharge. The time of postoperative respirator usage duration was shorter in those patients who underwent operation at ordinary temperature without cardiopulmonary bypass. CONCLUSION: The pulsatile bidirectional Glenn shunt, easy to perform and with good early postoperative effects, is a useful procedure in the early management of patients with a functional univentricular heart.