CAJ | 학술논문

目的总结婴幼儿完全性肺静脉异位引流(TAPVC)患儿的手术治疗经验及疗效分析.方法 2002年1月至2012年12月,本院采用手术治疗TAPVC 154例.其中男93例,女61例.手术年龄12～372(101.8±34.6)d,体质量3.0～10.0(5.02 ±2.96)kg.其中心上型78例,心下型6例,心内型62例,混合型8例.手术采用胸部正中切口入路,心上型和心下型TAPVC,将肺静脉共汇与左房顶做侧侧吻合.心内型充分剪除冠状静脉窦顶与房缺之间房隔组织,修补房缺并将冠状静脉窦隔于左心房.体外循环时间39～173(68.9±37.3)min;主动脉阻断时间18～110(41.3 ±20.7)min.结果本组手术早期及术后中期共死亡13例[8.4％ (13/154)],其中术后早期死亡9例(5.8％ 9/154),死亡原因:脱机困难2例,肺高压危象合并低心排综合征3例,肺部感染并发呼吸衰竭3例,肾功能衰竭l例;术后中期死亡死亡4例[2.6％ (4/154)],死亡原因:肺静脉回流梗阻3例,肺炎呼吸衰竭1例.余患儿随访1个月至10年,无死亡及因吻合口狭窄再次手术的患儿,复查心脏超声吻合口血流速度均＜1.4 m/s.结论 TAPVC患儿行手术治疗临床效果满意.
목적 총결영유인완전성폐정맥이위인류(TAPVC)환인적수술치료경험급료효분석.방법 2002년1월지2012년12월,본원채용수술치료TAPVC 154례.기중남93례,녀61례.수술년령12～372(101.8±34.6)d,체질량3.0～10.0(5.02 ±2.96)kg.기중심상형78례,심하형6례,심내형62례,혼합형8례.수술채용흉부정중절구입로,심상형화심하형TAPVC,장폐정맥공회여좌방정주측측문합.심내형충분전제관상정맥두정여방결지간방격조직,수보방결병장관상정맥두격우좌심방.체외순배시간39～173(68.9±37.3)min;주동맥조단시간18～110(41.3 ±20.7)min.결과 본조수술조기급술후중기공사망13례[8.4％ (13/154)],기중술후조기사망9례(5.8％ 9/154),사망원인:탈궤곤난2례,폐고압위상합병저심배종합정3례,폐부감염병발호흡쇠갈3례,신공능쇠갈l례;술후중기사망사망4례[2.6％ (4/154)],사망원인:폐정맥회류경조3례,폐염호흡쇠갈1례.여환인수방1개월지10년,무사망급인문합구협착재차수술적환인,복사심장초성문합구혈류속도균＜1.4 m/s.결론 TAPVC환인행수술치료림상효과만의.
Objective To summarize the experience of surgical treatment of total anomalous pulmonary venous drainage in newborn.Methods From March 2002 to May 2012,the 154 cases of patients with total anomalous pulmonary venous connection (TAPVC) were treated by operation in our department.There were 93 male and 61 female,aged from 12 days to 372 days with a mean of(101.8 ± 34.6) days,and weighted from 3.0 to 10.0 kg with a mean of (5.02 ± 2.96) kg.The specific types of TAPVC were supra-cardiac (50.6％,78/154),cardiac (40.2％,62/154),infra-cardiac (3.8％,6/154),and mixed (5.1％,8/154).Supracardic and infra-cardic TAPVC were chosen with side-to side anastomosis between the pulmonary veins confluence and the left atrium by median sternotomy.Cardic TAPVC were repaid by full cut off the top of coronary sinus,left atrium,and atrial septal tissue.The atrial septal defect(ASD) and let the ostium of the coronary sinus to left atrium was repaired.Cardiopulmonary bypass time was 39 ～ 173 (68.9 ± 37.3) ain ; aortic clamp time was 18 ～ 110 (41.3 ± 20.7) min.Results Total mortality rate was 8.4％ (13/154).The early mortality rate was 5.8％ (9/154),and the major cause of death was low cardiac output syndrome.The mid-term mortality rate was 2.6％ (4/154),and the major causes of death were pulmonary infection and postrepair pulmonary vein stenosis.Other patients were followed up from 1 months to 10 years,no death and anastomotic stenosis again operation in children.Echocardiographic results suggest that blood flow velocity in the anastomotic orifice was less than 1.4 m/s.Conclusions The clinical result of neonatal TAPVC who underwent operation treatment was satisfactory.