上海交通大学学报（医学版）

上海交通大学学报（医学版）

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非体外循环下分期全腔静脉-肺动脉连接术治疗复杂先天性心脏病

鲍春荣，梅 举，丁芳宝，张韫佼，汤 敏，朱家全，马 南   

  1. 上海交通大学 医学院附属新华医院心胸外科， 上海 200092
  • 出版日期:2014-06-28 发布日期:2014-06-30
  • 作者简介:鲍春荣（1977—）， 男， 副主任医师， 博士; 电子信箱: bcron@126.com。

Treatment of complex congenital heart diseases by total cavopulmonary connection without cardiopulmonary bypass

BAO Chun-rong, MEI Ju, DING Fang-bao, ZHANG Yun-jiao, TANG Min, ZHU Jia-quan, MA Nan   

  1. Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
  • Online:2014-06-28 Published:2014-06-30

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摘要：

目的 总结非体外循环下分期全腔静脉-肺动脉连接术(TCPC)治疗复杂先天性心脏病的临床经验。方法 29例复杂先天性心脏病患者行非体外循环下分期TCPC，其中单心室伴肺动脉狭窄11例，三尖瓣闭锁、右心室发育不良13例，三尖瓣下移畸形并右心室发育不良2例，完全性房室隔缺损伴右心室双出口、肺动脉狭窄3例。6例患者合并永存左上腔静脉，第一期手术行双侧双向Glenn术。患者双向Glenn术后平均23个月行非体外循环下TCPC。结果 患者术后无早期死亡，均痊愈出院。术后随访5～10年，失访7例，无中远期死亡。所有患者紫绀消失，血氧饱和度89%～97%，心功能Ⅰ级18例、Ⅱ级4例。结论 非体外循环下分期TCPC治疗复杂先天性心脏病效果良好，并发症较少。

关键词: 心脏缺损, 先天性, 全腔静脉-肺动脉连接术, 非体外循环

Abstract:

Objective To summarize the clinical experience of treating complex congenital heart diseases by the staged total cavopulmonary connection (CPC) without cardiopulmonary bypass (CPB). Methods Twenty nine patients with complex congenital heart diseases underwent staged TCPC without CPB. Among them, 11 cases had functional univentricle with pulmonary stenosis; 13 cases had tricuspid atresia with hypoplasia of right ventricle; 2 cases had Ebstein's anomaly with hypoplasia of right ventricle; and 3 cases had total atrioventricular septum defect with double outlet right ventricle and pulmonary stenosis. Six cases with left superior vena cava received the first stage operation of bilateral BDG and after twenty three months, they received the TCPC without CPB. Results There was no postoperative death. All patients were recovered and discharged. All patients except 7 cases were followed up for 5-10 years and there was no medium and long term death. The cyanosis of all patients was disappeared and their arterial oxygen saturation was 89%-97%. The cardiac function was class I for 18 patients and class II for 4 patients. Conclusion The staged TCPC without CPB has good outcomes with fewer complications.

Key words: heart defects, congenital, total cavopulmonary connection, off-pump