完全性肺静脉异位连接的外科治疗

目的 总结10例完全性肺静脉异位连接的外科治疗经验。方法 全组均在全身麻醉中度低温体外循环下进行手术，6例心上型患儿早期1例经后径法矫治，其他5例中3例经右心房切口径路矫治；另2例采用心上法矫治；4例心内型1例采用自体心包片将冠状静脉窦口经扩大的房间隔缺损隔入左心房，后3例用5-0 Prolene线连续缝合房间隔粗糙边缘后再矫治。结果 无手术死亡，发生心律失常3例，一过性肺水肿2例，均经治疗痊愈。全组随访4个月～5年，心功能正常。结论 提高手术成功率和防止术后并发症的关键为：术中吻合口要足够大，扩大左心房容积及术后及时处理心律失常、肺水肿和低心排血量。心内型矫治时消除房间隔粗糙面可防止术后肺静脉梗阻。

Surgical treatment for total anomalous pulmonary venous connection

Objective To evaluation the results of surgical treatment for 10 children with total anomalous pulmonary venous connection(TAPVC).Methods From June 1998 to December 2003, 10 patients aged from 3 months to 12 years (mean, 4.76 years) with TAPVC were treated in this institute. The type of deformities included supracardiac (6 cases) and intracardiac TAPVC (4 cases). The deformities were corrected by side-to-side anastomosis between pulmonary venous confluence and left atrium in 6 patients for supracardiac TAPVC and coronary sinus unroofing for 4 patients with intracardiac TAPVC. The correction was performed under cardiopulmonary bypass technology.Results There was no operative mortality. Three patients with arrhythmia and 2 with temporary pulmonary edema recovered uneventfully. And cardiac function returned to normal level in all patients during follow-up term of 4 months to 5 years.Conclusions The satisfactory results can be gained in children with TAPVC through following measures: enlargement of the incision of left atrial wall and common pulmonary venous, ligation of vertical vena proximally and enlargement of left atrium volume, and elimination of rough ringe of atrial septum.