CAJ | 학술논문

目的：评估外科手术治疗新生儿完全性肺静脉异位连接（TAPVC）的近中期临床疗效。 　　方法：2010-11至2014-01，我院确诊为TAPVC的新生儿20例（其中男性15例，女性5例）均接受外科手术治疗。平均手术年龄（10.2±4.8）d，体重（3.2±0.4）kg。所有患儿术前均行超声心动图检查，部分患儿行心脏计算机断层摄影术（CT）检查。术后1个月、3个月、6个月、12个月及24个月定为临床随访时间，复查以超声心动图为主，必要时复查心电图及X线胸片，怀疑肺静脉梗阻者加做心脏CT检查。 　　结果：全组无手术早期死亡，晚期死亡1例。平均体外转流时间（83.7±25.5）min，平均主动脉阻断时间（41.0±19.4）min。术后中位机械通气时间4 d（范围2~128 d），中位正性肌力药物支持时间3 d（范围2~128 d），中位住院时间21 d（范围13~128 d）。19例存活者中平均随访（19.5±11.8）个月，其中2例术前有双侧肺静脉发育不良仍伴重度肺动脉高压、心脏功能III级，其余17例恢复良好，心脏功能I~II级。 　　结论：外科手术治疗新生儿TAPVC近中期疗效满意，伴双侧肺静脉发育不良者预后不佳。
목적：평고외과수술치료신생인완전성폐정맥이위련접（TAPVC）적근중기림상료효。 　　방법：2010-11지2014-01，아원학진위TAPVC적신생인20례（기중남성15례，녀성5례）균접수외과수술치료。평균수술년령（10.2±4.8）d，체중（3.2±0.4）kg。소유환인술전균행초성심동도검사，부분환인행심장계산궤단층섭영술（CT）검사。술후1개월、3개월、6개월、12개월급24개월정위림상수방시간，복사이초성심동도위주，필요시복사심전도급X선흉편，부의폐정맥경조자가주심장CT검사。 　　결과：전조무수술조기사망，만기사망1례。평균체외전류시간（83.7±25.5）min，평균주동맥조단시간（41.0±19.4）min。술후중위궤계통기시간4 d（범위2~128 d），중위정성기력약물지지시간3 d（범위2~128 d），중위주원시간21 d（범위13~128 d）。19례존활자중평균수방（19.5±11.8）개월，기중2례술전유쌍측폐정맥발육불량잉반중도폐동맥고압、심장공능III급，기여17례회복량호，심장공능I~II급。 　　결론：외과수술치료신생인TAPVC근중기료효만의，반쌍측폐정맥발육불량자예후불가。
Objective: To evaluate the short- and mid-term outcomes for surgical correction of total anomalous pulmonary venous connection (TAPVC) in neonates. Methods: A total of 20 neonates with TAPVC who received surgical correction in our hospital from 2010-11 to 2014-01 were respectively studied. There were 15 male and 5 female neonates with the average age of (10.2 ± 4.8) days and body weight of (3.2 ± 0.4) kg. All patients received pre-operative echocardiography and some of them received CT examination. The followed-up study was conducted at 1, 3, 6, 12 and 24 months after the operation respectively, the patients were mainly examined by echocardiography, ECG and chest X-ray were used as necessary, the cardiac CT would be performed if the patient with suspected pulmonary venous obstruction. Results: There was no early post-operative death, 1 patient died at late post-operation. The average cardiopulmonary bypass time was (83.7 ± 25.5) minutes and the average aortic cross clamp time was (41.0 ± 19.4) minutes. The median duration of post-operative ventilation time was 4 days with the range from 2 to 128 days, the median inotropic medication supporting time was 3 days with the range from 2 to 128 days, and the median hospitalization time was 21 days with the range from 13 to 128 days. The mean follow-up time for 19 survivors was at (19.5 ± 11.8) months, and 2 of them were with pre-operative bilateral pulmonary vein hypoplasia combining severe pulmonary hypertension and NYHA III;the rest 17 patients recovered well and they had NYHA I to NYHA II. Conclusion: The short- and mid-term outcomes were good for surgical correction of TAPVC in neonates, the patients with bilateral pulmonary vein hypoplasia had poor prognosis