一期或分期全腔静脉-肺动脉连接术治疗功能性单心室

目的总结、比较一期和分期全腔静脉-肺动脉连接术(total cavopulmonary connection,TCPC)治疗复杂先天性心脏病的疗效。方法分析2003年12月至2007年9月在广东省人民医院住院,适合一期生理矫治并施行了一期TCPC术的患儿25例和已先期完成第一阶段姑息手术并施行了二期TCPC术的患儿17例的临床资料。前期手术包括15例双向Glenn手术、1例体-肺分流术、1例三尖瓣下移畸形矫治加双向Glenn手术。一期TCPC组中14例采用外管道,11例肺动脉直接下拉与下腔静脉吻合。二期TCPC组中15例采用外管道,1例采用心房内通道,1例肺动脉直接与下腔静脉吻合。结果早期死亡4例,病死率9.5%(4/42)。一期TCPC组死亡3例,病死率12.0%(3/25);二期TCPC组死亡1例,病死率5.9%(1/17)。二期TCPC组的辅助通气时间、胸管停留时间、住监护室时间、术后住院天数比一期TCPC组短,但差异无统计学意义(P0.05)。随访8个月到4.8年。1例于术后8个月死于严重的房室瓣反流、心力衰竭。结论一期和分期TCPC手术治疗复杂先心病都能达到良好的效果。

Surgical treatment of functional single ventricle with one-stage or two-stage total cavopulmonary connect

Objectives To summarize the treatment of congenital heart diseases with total cavopulmonary connection （TCPC） and to commpare the effects of one-stage and two-stage procedure.Methods From December 2003 to September 2007,25 cases underwent one-stage TCPC and 17 cases underwent two-stage TCPC.The preceding procedures included bidirectional Glenn shunt （15 case）,A-P shunt （1 case） and tricuspid valve repaire added bidirectional Glenn shun （1 case）.Among the one-stage group,extracardiac conduits were applied on 14 cases while direct anastomosis between pulmonary trunk and inferior vena cava was used in 11 cases.Among the two-stage group ,extracardiac conduits were applied on 15 case;intracardiac conduit was used in one case,and direct anastomosis between pulmonary trunk and inferior vena cava was used in the rest one.Results Among the all,there were 4 death,the total motality was 9.5%（4 / 42）.Three of them were in one-stage group,with the motality 12.0%（3 / 25）;one of them was in two-stage group,with the motality 5.9% （1 / 17）.The mechanical ventilating time,the stayment of chest tube,the duration of ICU,and the post- operative hospitalized duration of two-stage group were shorter than those of one-stage group,though there was no significant difference between the 2 groups.Conclusions Both one-stage and two stage TCPC can have perfect effect on the treatment of complex congenital heart diseases.