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目的探讨左心房内吻合术治疗心下型完全性肺静脉异位引流的效果。方法对32例心下型完全性肺静脉异位引流新生儿实施深低温体外循环下左心房内吻合术。结果本组手术顺利,23例患儿术后延迟关胸,无手术死亡病例。5例心脏复跳后心率较慢安装临时心脏起搏器,术后1~5 d心率恢复正常。除2例因低心排综合征于术后早期死亡,其余患儿均治愈出院。3例患儿术后反复出现肺部感染,2例出现气胸,给予抗感染,胸腔闭式引流均匀恢复。1例心脏超声提示发现主动脉弓有缩窄,再次手术解除主动脉弓缩窄,痊愈出院。28例随访3个月~5 a,行心脏超声、胸片检查。患儿心功能良好,吻合口血流速度正常。结论对心下型完全性肺静脉异位引流新生儿实施左房后壁心内吻合手术,吻合口充分,有利于提高术后恢复效果。
Objective To investigate the effect of left atrial anastomosis in the treatment of subaxillary complete pulmonary venous anomalous drainage. Methods Thirty-two neonates with subaxillary complete anomalous pulmonary venous drainage were subjected to left atrial anastomosis under deep hypothermic cardiopulmonary bypass. Results The operation was successful in this group. Twenty-three patients had delayed thoracotomy without any surgical death. 5 cases of heart rate after cardioplegia slower installation of temporary pacemakers, 1 ~ 5 days after the heart rate returned to normal. In addition to 2 cases due to low cardiac output syndrome in the early postoperative death, the remaining children were cured and discharged. Three cases of recurrent pulmonary infection after surgery, 2 cases of pneumothorax, given anti-infection, thoracic drainage closed uniform recovery. One case of echocardiography showed a narrowing of the aortic arch, reoperation to aortic arch atrophy, and was discharged. Twenty-eight cases were followed up for 3 months to 5 years, underwent echocardiography and chest radiography. Children with good heart function, anastomotic blood flow rate was normal. Conclusions The left anterior posterior wall anastomosis can be performed on infants with heterotopic inferior pulmonary artery drainage. The anastomosis is sufficient to improve the postoperative recovery.