论文部分内容阅读
目的总结23例婴儿完全性肺静脉异位连接(totalanomalous pulmonary venous connection,TAPVC)的外科治疗经验。方法全组均在中度低温体外循环下进行手术,其中急诊手术6例。患儿平均年龄(5.7±3.6)个月,平均体重(5.8±1.5)kg。心上型11例采用双房径路矫治并结扎垂直静脉,用可吸收缝线吻合肺静脉共干与左心房后壁切口;心内型12例,仔细辨认合并三房心畸形,避免损伤传导系统。均采用心包补片修补扩大的房间隔缺损。结果手术早期死亡2例(死亡率8.7%)。18例随访2个月～3年,患儿心功能明显改善,生长发育正常。结论TAPVC可由超声心动图确诊,应尽早手术矫治。对于新生儿或婴儿期反复出现肺炎、低氧血症、心衰等患儿,在临床症状相对改善的情况下应急诊手术;同时加强体外循环和监护室的密切协作,完善术后处理方法。
Objective To summarize the surgical experience of TAPVC in 23 infants with complete pulmonary venous connection (TAPVC). Methods All patients underwent moderate hypothermic cardiopulmonary bypass surgery, including emergency surgery in 6 cases. The average age of children (5.7 ± 3.6) months, the average body weight (5.8 ± 1.5) kg. Eleven cases of supranuclear type were treated with double-room approach and ligated with vertical veins. The absorbable suture was used to make anastomosis of the common pulmonary veins and the posterior wall of the left atrium. In 12 cases of cardioembolic type, three cases of congenital heart deformity were carefully identified to avoid damage to the conduction system. Pericardial patch are used to repair an enlarged atrial septal defect. Results 2 cases died of early surgery (mortality 8.7%). 18 cases were followed up for 2 months to 3 years, children with cardiac function improved significantly, normal growth and development. Conclusion TAPVC can be diagnosed by echocardiography, surgical correction should be as soon as possible. For neonates or infants with recurrent pneumonia, hypoxemia, heart failure and other children under the condition of the relative improvement in clinical emergency response surgery; while strengthening cardiopulmonary bypass and intensive care unit to improve postoperative management.