CAJ | 학술논문

目的总结全腔静脉肺动脉连接术(TCPC)的临床经验,探讨该术式的应用范围及近、中期效果.方法回顾性总结了自1999年至2007年31例TCPC患者的临床资料,全部病例分为儿童组(≤16岁,21例)和成人组(10例),全部病例中单心室15例,完全性心内膜膜垫缺损并右心室双出口8例,完全性大动脉转位并右心室双出口3例,三尖瓣闭锁3例,右心室双出口并左心室发育不良1例,矫正型大动脉转住并法洛四联症1例.其中合并3房心1例,永存左上腔10例,二尖瓣中、重度返流1例,共同瓣中度返流3例.所有病例均合并肺窄且肺动脉发育良好.行TCPC,其中心内隧道10例,心外管道21例;28例在体外循环下手术,3例为非体外循环手术.结果儿童组无囤术期死亡,无顽固性胸腔积液;成人组死亡2例,3例出现顽固性胸腔积液,1例出现下腔静脉淤滞症状,经治疗后消失.随访6个月至8年,心功能Ⅰ级26例,Ⅱ级2例,Ⅲ级1例.结论 TCPC手术是功能性矫治先天性心脏病复杂畸形的有效方法,成人术后并发症较多,近、中期效果主要与房室瓣返流有关.
목적 총결전강정맥폐동맥련접술(TCPC)적림상경험,탐토해술식적응용범위급근、중기효과.방법 회고성총결료자1999년지2007년31례TCPC환자적림상자료,전부병례분위인동조(≤16세,21례)화성인조(10례),전부병례중단심실15례,완전성심내막막점결손병우심실쌍출구8례,완전성대동맥전위병우심실쌍출구3례,삼첨판폐쇄3례,우심실쌍출구병좌심실발육불량1례,교정형대동맥전주병법락사련증1례.기중합병3방심1례,영존좌상강10례,이첨판중、중도반류1례,공동판중도반류3례.소유병례균합병폐착차폐동맥발육량호.행TCPC,기중심내수도10례,심외관도21례;28례재체외순배하수술,3례위비체외순배수술.결과 인동조무돈술기사망,무완고성흉강적액;성인조사망2례,3례출현완고성흉강적액,1례출현하강정맥어체증상,경치료후소실.수방6개월지8년,심공능Ⅰ급26례,Ⅱ급2례,Ⅲ급1례.결론 TCPC수술시공능성교치선천성심장병복잡기형적유효방법,성인술후병발증교다,근、중기효과주요여방실판반류유관.
Objective To summarize the clinical experiences of total cavopulmonary connection (TCPC), investigate the applications and short and mid term effects. Methods From 1999 to 2007,31 patients with complex congenital heart disease underwent TCPC. All patients were divided into child group(≤16 years old ,n =21 ) and a-dult group( n = 10 ), including 15 cases of functional univentricle, 8 cases of complete atrioventricular septal defect with double outlet of right ventricle, 3 cases of transposition with double outlet right ventricle, 3 cases of tricuspid atresia, 1 case of double outlet of right ventricle with hypoplastic left heart. 1 case of corrected transposition of the great arteries with TOF. Among them, 1 patient had cortriatriatum, 10 patients had left superior vena cave, moderate or severe mitral valve insufficiency occurred in 1, moderate atrioventricular valve insufficiency occurred in 3.28 pa-tients underwent TCPC with cardiopulmonary bypass ( CPB ) and 3 patients without CPB ;Of them, 21 patients were treated with extracardiac conduit and 10 cases with intratrial lateral tunnel. Results There was no early death,post-operative death or large quantities of pleural effusion in child group;but two deaths and three patients with large quantities of pleural effusion in adult group. One case caught up in inferior venous stasis and was cured. Follow- up was carded out from 6 months to 6 years. 26 patients were in NYHA class Ⅰ ,2 patients in NYHA class Ⅱ and only one patient in NYHA class Ⅲ. Conclusions TCPC is effectively used for complex congenital heart disease which can not be corrected in anatomy;serious postoperative complications often occur in adults. Atrioventricular valve in-sufficiency decisively affects the short and midterm effects, even the long-term effects.