婴幼儿完全性房室间隔缺损的外科治疗

目的：研究婴幼儿完全性房室间隔缺损（CAVSD）的外科治疗效果,探讨不同手术方法的特点.方法：2005年1月至2011年12月,CAVSD患儿142例,手术年龄2个月～6岁,平均（12.5）个月,中位年龄7个月,年龄＜6个月65例,6～12个月43例,12个月以上34例.体质量3.5 ～ 19 kg,平均（7.1±3.3）kg.采用改良单片法105例（73.9％）,37例室间隔缺损高度超过缺损宽度50％以上的患儿采用双片法（26.1％）.结果：全组手术早期病死率4.9％ （7/142）,分别死于肺动脉高压危象2例,低心排出量综合征（低心排）3例,败血症2例.不同手术年龄的三组病例手术病死率分别为4.6％、4.7％和5.9％,差异无统计学意义.按改良单片法和双片法分组手术病死率分别为3.8％ （4/105）和8.1％（3/37）,差异有统计学意义（P＜0.05）.体外循环时间和主动脉阻断时间改良单片法组明显低于双片法组,差异有统计学意义（P＜0.05）,而在不同年龄组间差异无统计学意义.而术后二尖瓣反流在各组差异均无统计学意义.结论：CAVSD应该早期诊断和早期手术治疗,3～6个月月龄是适宜的手术时机,改良单片法可适用于大部分病例,有效简化手术操作缩短手术时间,瓣膜修复效果于双片法相仿.

Surgical management of complete atrioventricualr septal defect

Objective：To investigate the optimal surgical approaches for complete atrioventricular septal defect. Methods： 142 patients undergoing total correction for complete atrioventricular septal defect （CAVSD） from January 2005 to December 2011 were classified to the modified single-patch technique group （105 pa- tients, 73.9% ） and the classical two-patch technique group （37 patients, 26. 1% ）. All patients were divided into three groups, 〈 6 months, 6 - 12 months, 〉 12 months. Results： There were 7 patients died early after surgery （4. 9% ） ,2 cases died from pulmonary hypertension crisis, 3 cases died from low cardiac output syn- drome and sepsis in 2 cases. The surgical outcomes of the modified single-patch technique were compared with those of the classical two-patch technique. The aortic cross-clamp time and cardiopulmonary bypass time were shorter in the modified single-patch technique group （ P 〈 0. 05 ）. There is no significant difference in the surgi- cal mortality and mitral valve function between these two groups. Conclusion： CAVSD should be early diagno- sis and surgical treatment, 3 -6 months of age is appropriate timing for surgery. And the modified single-patch technique has the advantage of relative simplicity and shorter ischemic time, and it is thought to be a feasible surgical option for the repair of CAVSD.