【摘要】 目的评价腔静脉主动脉转流(cava-aortic bypass,CAB)下全腔静脉肺动脉连接术(total cavopulmonary connection,TCPC)的临床应用价值。方法2006年7月至2007年8月,5例病人接受了CAB下的TCPC术,其中三尖瓣闭锁(tricuspid atresia,TA)4例,单心室1例。所有病人均有不同程度的肺动脉(瓣)狭窄,其中3例合并右室流出道(right ventricularoutlettract,RVOT)狭窄。所有病人均使用心外管道。1例曾行双向Clenn分流术。结果术后近期效果:5例病人中4例存活,脉搏血氧饱和度(sP02)由术前的72%~80%升高至87%~98%,活动能力明显改善,超声显示外管道通畅,无血栓形成,1例TA合并RVOT狭窄的病人术后26d死于上消化道出血、肺部感染及多脏器功能衰竭。2例TA病人发生双侧胸腔积液,经置胸腔引流管和综合性治疗。分别于术后20d和22d痊愈出院。手术后中期效果:术后随访3至16个月,4例病人均存活,生活质量明显改善,心功能Ⅰ~Ⅱ级,无恶性心律失常、血栓形成和脑部并发症发生。结论CAB下的TCPC术操作较简便,手术安全性较好,且避免了CPB带来的并发症,具有较满意的近中期效果。更多还原

【Abstract】 Objective To evaluate the clinical application of total cavopulmonary connection(TCPC) with cava-aortic bypass.Methods From July 2006 to August 2007,5 patients,who had complex congenital heart diseases with single functional ventricle,underwent TCPC with CAB and without cardiac arrested.Ages were from 8 to 16 years and body weights were from 31 to 60 kilograms.The diseases included tricuspid atresia 4 cases and single ventricle 1 case.All patients had stenosis of pulmonary valve and 3 of them had stenosis of right ventricular outlet tract.All patients were completed with the extracardiac conduit.One patient had received bidirectional Glenn shunt before 3 years.Results During the early postoperative period,four patients survived with oxygen saturation increased from 72%~80%to 87%~98%.The exercise capacity was significantly improved.There was no thrombus formation in the conduit.One patient died in upper gastrointestinal hemorrhage,lung infection and multiple organs failure at 26 days after operation.Two patients had pleural effusion postoperatively,and both of them had uneventful recovery.All 4 patients were followed up for 3 to 16 months with no death.The cardiac function of all patients were grade I~ II,The life quality of the patients was greatly improved.There were no complications like severe arrhythmia,thrombosis and cerebral problems.Conclusion TCPC with CAB is safe and easy lo perform.Without oxygenator application.This technique can escape from many complications caused by CPB and the early and mid-term clinical outcomes are satisfactory.However,much remains to be studied about this bypass procedure.更多还原