心外管道全腔静脉-肺动脉连接术在复杂先天性心脏病外科治疗中的应用

目的总结心外管道全腔静脉-肺动脉连接术治疗复杂先天性心脏病的应用经验及其治疗效果。方法回顾性分析2006年9月至2012年12月间广州军区广州总医院心脏外科中心52例行心外管道全腔静脉-肺动脉连接术患者的临床资料。12例行一期心外管道全腔静脉-肺动脉连接术，40例为双向Glenn手术后行二期心外管道全腔静脉-肺动脉连接术。分析所有患者的临床资料，并比较两种手术方式患者的死亡率、并发症发生率、住院时间、住重症监护室（ICU）时间、机械辅助通气时间、动脉血氧饱和度的改善情况等。结果围术期死亡2例，死亡率3．8％。其中1例术后因严重低心排血量综合征死亡，1例术后因多器官功能衰竭死亡；50例治愈出院。二期心外管道全腔静脉．肺动脉连接术患者（40例肌械辅助通气时间、住ICU时间、住院时间明显短于一期心外管道全腔静脉-肺动脉连接术患者（12例），但两种手术方式患者术后并发症发生率及术后动脉血氧饱和度（二期手术与一期手术比较：93％±3％vs．94％±3％）、死亡率（二期手术与一期手术比较：2．5％vs．8．3％）差异均无统计学意义（P〉0．05）。随访45例（90％），随访时间6～52个月，随访期间无死亡。术后3个月，存活患者心功能均为Ⅰ～Ⅱ级，心脏彩色超声心动图显示：腔静脉肺动脉吻合口血流通畅。结论心外管道全腔静脉．肺动脉连接术血流动力学更符合生理血流动力学特点，手术操作简捷，是不能进行双心室治疗时的有效手术术式；分期心外管道全腔静脉-肺动脉连接术较一期心外管道全腔静脉-肺动脉连接术手术适应证广泛，术后恢复较好，更易推广。

Extracardiac Conduit Total Cavopulmonary Connection for Surgical Treatment of Complex Congenital Heart Diseases

Objective To summarize clinical experience and outcomes of extracardiac conduit total cavopulmonary connection （TCPC） for surgical treatment of complex congenital heart diseases. Methods Clinical data of 52 patients who underwent extracardiac conduit TCPC from September 2006 to December 2012 in Department of Cardiac Surgery, Guangzhou General Hospital of Guangzhou Military Command were retrospectively analyzed. There were 12 patients who received one-stage extracardiac conduit TCPC. There were 40 patients who received two-staged extracardiac conduit TCPC after bidirectional Glenn procedure. Clinical data of all the patients were analyzed. Mortality, morbidity, length of hospital stay and intensive care unit （ICU） stay, mechanical ventilation time, change of arterial oxygen saturation （SaO2）were compared between the 2 groups. Results Two patients （3.8%） died postoperatively including 1 patient with severe low cardiac output syndrome and another patient with multiple organ dysfimction syndrome. Fifty patients were discharged successfully. Mechanical ventilation time, length of ICU stay and hospital stay of the 40 patients who received two-stage extracardiac conduit TCPC were significantly shorter than those of the 12 patients who received one-stage extracardiac conduit TCPC. There was no statistical difference in postoperative morbidity, SaO2 （two-staged vs. one-staged： 93%±3% vs. 94%±3%） or mortality （two-staged vs. one-staged： 2.5% vs.8.3%） between the 2 groups （P 〉 0.05 ）. Forty-five patients （90%） were followed up for 6-52 months, and there was no death during follow-up. At 3 months after TCPC, all the patients had heart function of class I or II, and echocardiography showed patent cavopulmonary anastomosis. Conclusion Extracardiac conduit TCPC is a simple procedure, can produce more physiological hemodynamic results, and can be performed for patients who cannot undergo biventricle procedure. Compared with one-stage extracardiac conduit TCPC, two-staged extracardiac conduit TCPC has wider surgical indications, can produce better postoperative recovery, and is easier to perform.