中华胸心血管外科杂志
中華胸心血管外科雜誌
중화흉심혈관외과잡지
Chinese Journal of Thoracic and Cardiovascular Surgery
2010年
4期
221-223
,共3页
肖明第%冯晓东%张建卿%张伟%李伟%贾宝成%万亚红%王吉祥%张帆%陈明宝%张学勤
肖明第%馮曉東%張建卿%張偉%李偉%賈寶成%萬亞紅%王吉祥%張帆%陳明寶%張學勤
초명제%풍효동%장건경%장위%리위%가보성%만아홍%왕길상%장범%진명보%장학근
Cantrell五联症%心脏缺损,先天性%心脏外科手术
Cantrell五聯癥%心髒缺損,先天性%心髒外科手術
Cantrell오련증%심장결손,선천성%심장외과수술
Pentalogy of Cantrell,Heart defects,congenital%Cardiac surgical procedures
目的 总结8例Cantrell五联症病例的手术经验.方法 2007年7月至2009年6月在心外科、胸外科及普外科协作下,采用相应的手术方式矫治8例Cantrell五联症病儿,其中男6例,女2例;平均年龄7.35岁.心内畸形包括室间隔缺损合并房间隔缺损或卵圆孔未闭4例、右室双出口2例,单纯房间隔缺损和单纯室间隔缺损各1例.结果 1例于右室双出口矫治手术后2年二期行心脏回纳手术,手术切开左侧部分肝冠状韧带及部分肝镰状韧带,向下推移肝脏左叶,打开双侧胸膜,切除双侧肋缘部分肋软骨,上拾胸壁,回纳心脏到胸腔,并采用Proceed补片修补膈肌、腹壁缺损外,其余7例均在双侧心包及纵隔胸膜充分打开的同时将第7、8肋软骨横断、闭合两侧肋弓行胸廓成形术,即均一期行心脏畸形矫治及心脏回纳手术.8例心内及心外畸形矫治满意,其中例2术后出现残余漏,经心内科介入封堵后治愈;例4左心室憩室病儿,行憩室切除,残端缝闭术;例6右室双出口者根治手术后出现右心功能不全,对症治疗后恢复.术后随访1～23个月,手术效果满意,无严重不良并发症发生,生活状况良好.结论 精确矫治Cantrell五联症的心脏畸形,打开双侧胸膜,切断肋软骨上抬胸壁,扩大心脏回纳空间,必要时人工补片修复膈肌缺损,本畸形多能达到一期治疗目的 .
目的 總結8例Cantrell五聯癥病例的手術經驗.方法 2007年7月至2009年6月在心外科、胸外科及普外科協作下,採用相應的手術方式矯治8例Cantrell五聯癥病兒,其中男6例,女2例;平均年齡7.35歲.心內畸形包括室間隔缺損閤併房間隔缺損或卵圓孔未閉4例、右室雙齣口2例,單純房間隔缺損和單純室間隔缺損各1例.結果 1例于右室雙齣口矯治手術後2年二期行心髒迴納手術,手術切開左側部分肝冠狀韌帶及部分肝鐮狀韌帶,嚮下推移肝髒左葉,打開雙側胸膜,切除雙側肋緣部分肋軟骨,上拾胸壁,迴納心髒到胸腔,併採用Proceed補片脩補膈肌、腹壁缺損外,其餘7例均在雙側心包及縱隔胸膜充分打開的同時將第7、8肋軟骨橫斷、閉閤兩側肋弓行胸廓成形術,即均一期行心髒畸形矯治及心髒迴納手術.8例心內及心外畸形矯治滿意,其中例2術後齣現殘餘漏,經心內科介入封堵後治愈;例4左心室憩室病兒,行憩室切除,殘耑縫閉術;例6右室雙齣口者根治手術後齣現右心功能不全,對癥治療後恢複.術後隨訪1～23箇月,手術效果滿意,無嚴重不良併髮癥髮生,生活狀況良好.結論 精確矯治Cantrell五聯癥的心髒畸形,打開雙側胸膜,切斷肋軟骨上抬胸壁,擴大心髒迴納空間,必要時人工補片脩複膈肌缺損,本畸形多能達到一期治療目的 .
목적 총결8례Cantrell오련증병례적수술경험.방법 2007년7월지2009년6월재심외과、흉외과급보외과협작하,채용상응적수술방식교치8례Cantrell오련증병인,기중남6례,녀2례;평균년령7.35세.심내기형포괄실간격결손합병방간격결손혹란원공미폐4례、우실쌍출구2례,단순방간격결손화단순실간격결손각1례.결과 1례우우실쌍출구교치수술후2년이기행심장회납수술,수술절개좌측부분간관상인대급부분간렴상인대,향하추이간장좌협,타개쌍측흉막,절제쌍측륵연부분륵연골,상습흉벽,회납심장도흉강,병채용Proceed보편수보격기、복벽결손외,기여7례균재쌍측심포급종격흉막충분타개적동시장제7、8륵연골횡단、폐합량측륵궁행흉곽성형술,즉균일기행심장기형교치급심장회납수술.8례심내급심외기형교치만의,기중례2술후출현잔여루,경심내과개입봉도후치유;례4좌심실게실병인,행게실절제,잔단봉폐술;례6우실쌍출구자근치수술후출현우심공능불전,대증치료후회복.술후수방1～23개월,수술효과만의,무엄중불량병발증발생,생활상황량호.결론 정학교치Cantrell오련증적심장기형,타개쌍측흉막,절단륵연골상태흉벽,확대심장회납공간,필요시인공보편수복격기결손,본기형다능체도일기치료목적 .
Objective To summarize surgical experience of eight patients with pentalogy of Cantrell. Methods Six male and two female patients with pentalogy of Cantrell,aged from 4 months to 26 years old, average 7.35 years old, underwent surgical therapy for intracardiac anomalies and extracardiac anomalies from July 2007 to June 2009. Eight case with intracardiac anomalies include one case with only VSD, one case with only ASD, two cases with DORV, four cases with VSD and ASD or PTO. Experts majoring in cardiovascular surgery cooperated with doctors majoring in thoracic surgery and general surgery for satisfactory correction of intracardiac anomalies and extracardiac anomalies and repositioning heart to thoracic cavity. Results Ectopic heart of the first patient was simply repositioned into thoracic cavity following surgery of double outlet of right ventricle in another hospital two years before. Correction of introcardiac anomaly and reposition of ectopic heart finished at one time in 7 cases. Eight patients got full recovery except that residual shunt occurred in the second case which also got full recovery after transcatheter therapy. Ventricular diverticulum was removed in the fourth case because of difficult reposition of ectopic heart.With the help of general surgeon and thoracic surgeon, partial coronary ligament of liver and falciform ligament of liver in the left was cut in the first case and the left half lobe of liver was pushed downward. Bilateral pleural and marginal costal costochondral was cut and make thoracic wall upward so that ectopic heart can reset into thoracic cavity. And then, defect of diaphragm and abdominal wall were repaired with Proceed patch. In the other seven cases, bilateral pericardium and mediastinal pleura was cut and the 7th and 8th cartilage was transected and bilateral costal arch was closed so for complete thoracic angioplasty.Left ventricular dysfunction occurred in the fifth case with DORV and also got full recovery after symptomatic treatment. Full recovery was got in all cases after followingup from 1 to 23 months. No adverse complications occurred and every case live a wonderful life. Conclusion Pentalogy of Cantrell can be cured at one time by accurate correction of cardiac anomalies, cutting of bilateral pleural and marginal costal costochondral to make thoracic wall upward and enlarge thoracic space for repositinning of ectopic heart and using artificial patch to repair defect of diaphragm when necessary.
