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（total anomalous pulmonary venous drainage，TAPVD）的外科治疗经验。方法TAPVD27例（心上型15例，心内型12例）均在体外循环下手术。心上型6例采用传统双心房联合切口，9例采用心上法，后者经上腔静脉与升主动脉之间显露左心房与共同静脉干行-一侧吻合：心内型切开房间隔缺损与冠状静脉开口之间的残余房间隔壁，自体心包将肺静脉开口与冠状静脉窦隔入左心房。结果早期死亡2例，其他病人痊愈出院，术后随访3个月-4年，恢复良好，无吻合口狭窄发生，出院后无因心、肺衰竭死亡病人。结论TAPVD早期诊断极为重要，手术治疗的关键在于左心房与肺总静脉吻合口应足够大，避免狭窄的发生。

Surgical treatment of total anomalous pulmonary venous drainage

Objectives To summarize the experience of surgical treatment of total anomalous pulmonary venous drainage (TAPVD). Methods Twenty-seven cases (fifteen with supercardiac type, twelve with intracardiac type) underwent surgical correction under cardiopulmonary bypass. Six of the supercardiac type of TAPVD were corrected by left atrium associated with right atrium approach, Nine of them were corrected by the superior approach. The latter approach was that the top of the left atrium and the common pulmonary venous trunk were exposed through the place between superior vena cava and ascending part of aorta and anastomosis between them was done. In intracardiac type of TAPVD the atrial septal defects were enlarged and common veins were boarded to the left atria with pericardial patches. Results There were 2 deaths directly related to the operation. According to follow-up data of 3 months to 4 years, there was no anastomotic stenosis and death case for heart failure and respiratory failure after discharge. Conclusions Early diagnosis is critical for the cases with TAPVD. The success of operation depends on the bigger enough anastomotic orifice and avoidance the anastomotic stenosis.