【摘要】 目的探讨在非体外循环下行双向腔肺分流术治疗复杂先天性心脏病的手术适应证、外科技巧、术后处理和疗效。方法在非体外循环下行双向格林手术6例。3例建立上腔静脉-右心房临时转流,自上腔静脉入右房处横断上腔静脉,封闭近心端,不阻断肺动脉的情况下应用可吸收线端侧吻合远心端与右肺动脉,前壁用自体心包片加宽。3例利用双上腔互为旁路行双侧双向腔肺分流术。结果全组无手术死亡,无并发症发生。手术时间缩短,不用输血,呼吸机辅助呼吸时间3.5~45h,肺动脉压由术前的(15.20±3.34)mmHg升高到(18.40±4.67)mmHg,末梢动脉血氧饱和度(SO2)由术前0.76±0.06升高到0.92±0.04,胸液量130~640ml。结论对于难以解剖根治或一期生理矫治的肺血少的复杂先天性心脏病,只要把握好手术适应证,注意手术操作,加强术后管理,在非体外循环下行双向腔肺分流术是一种很好的选择。更多还原

【Abstract】 Objective To evaluate operative indications,surgical skill,postoperative management and outcomes of the bidirectional Glenn shunt without cardiopulmonary bypass in the treatment of complex congenital heart anomalies. Methods Six patients underwent bidirectional Glenn shunt without cardiopulmonary bypass. A temporary shunt was established between the superior rena cava (SVC) and right artrium (RA) for venous drainage during SVC clamping for the bidirectional cavopulmonary anastomosis. Results All patients survived after surgery. There was no postoperative complication. The time of operation was shortened, and blood transfusion was not needed. The mechanical ventilation time was 3.5 to 45 h. SO2 was significantly improved after operation (0.76±0.06) vs(0.92±0.04). Postoperative pulmonary artery pressure was(18.40±4.67)mmHg. The drainage was 130 to 640 ml. Conclusion Complex congenital heart anomalies with inadequate lung blood flow when anatimic and primary physiological correction are not suitable for operation. A surgeon must grasp operative indications and pay attention to surgical skills, and improve postoperative management, then the bidirectional Glenn shunt without cardiopulmonary bypass is a feasible choice.更多还原