全腔肺动脉连接术在复杂先心病治疗中的应用

目的 旨在探讨全腔肺动脉连接术在复杂先心病治疗中应用的几个问题，以提高其治疗效果和存活率。方法 回顾分析全腔肺动脉连接术在复杂先心病治疗中的体会，并对全腔肺动脉连接术在术式选择及其影响因素方面进行讨论。2001年8月至2005年5月25例复杂先心病患者在协和医院行全腔肺动脉连接术。其中完全性大动脉转位（TGA）5例，完全性房室通道并右室双出口（AVC＋DORV）11例，三尖瓣闭锁（TA）5例，单心室4例。4例合并永存左上腔静脉（PLSVC）。所有患者均有不同程度的肺动脉瓣和右室流出道狭窄或闭锁。所有患者均在体外循环下完成，22例心内隧道引流下腔，其中开窗12例；3例心外管道引流下腔。结果 23例存活，SaO2≥90％，中心静脉压（CVP）15～18cmH2O，无心律失常；2例死亡（8％），死于低心排血量和严重缺氧。术后并发灌注肺3例、反复胸水乳糜胸2例、1例肾功能不全、1例心内隔片片周漏行再次心内修补。结论 全腔肺动脉连接术是不能进行双心室治疗时的有效术式，术前仔细选择适应证、术中适当的术式设计、术后对并发症较好的处理可有效提高存活率。

Application of Total Cavopulmonary Connection in Complex Cardiac Anomalies

Objective To explore the clinical application of total cavopulmonary connection(TCPC) in treatment of some complex cardiac anomalies for ameliorating the curative effectiveness and survival rate.Methods The clinical data of TCPC in the treatment of 25 cases of complex cardiac anomalies from Aug.2001 to May 2005 was retrospectively analyzed,and the selection of surgical procedures and the influencing factors were also discussed.Among them,there were 5 cases of transposition of great arteries(TGA),11 cases of atrioventricular canal with double output of right ventriculum(AVC DORV),5 cases of tricuspid atresia(TA),4 cases of univentriculum.Four cases of persistent left superior veno cava(PLSVC) were complicated among them.All patients had stenosis even atresia of right ventricular outlet and pulmonary valve.All the procedures were done under cardiopulmonary bypass.SVC were anastomosed to RPA right to IVC,the later were flared with pericardium.Twenty-two cases were subjected to intracardiac TCPC with 3-5 mm fenestration in 12 patients, and 3 to extracardiac TCPC using(15-17) mm vessel prosthetics.Two cases of PLSVC were drained into intraatrial tunnel in the early and the other 2 were anastomosed to LPA later.Results Twenty-three patients survived. Oxygen saturation was over 90% and CVP was 15-18 cmH_(2)O.Two patients(8 %) died of low cardiac output and anoxia.Postoperative perfusion lung occurred in 3 cases,pleural leakage of seroma and lymphotube in 2 cases,renal function failure in 1 case,two patients received reoperations for intraatrial baffle leakage.Conclusion TCPC was an effective procedure for some complex cardiac anomalies especially for functional single ventriculum or single atrioventricular valve.The survival rate after TCPC can be raised by choosing adequate indication before operation,designing procedures during operation and treating complications after operation.