完全性肺静脉异位连接的手术治疗_临床医学论文.docVIP

完全性肺静脉异位连接的手术治疗_临床医学论文 完全性肺静脉异位连接的手术治疗_临床医学论文 作者：孔德平 查光彦 刘静魁 孙仕斌 姜德哲 【关键词】 胸外科手术 　　【摘要】 目的 回顾总结完全性肺静脉异位连接（TAPVC）的手术治疗。方法 1988年1月~2005年9月间共救治TAPVC 87例，年龄4个月~14岁，平均（2.98±3.6）岁，体重4~28kg，平均（7.62±5.4）kg。全组心上型51例，心内型28例，心下型1例，混合型7例。早期6例心上型TAPVC采用心脏上翻方法；后30例采用右房横切口，经房间隔左房后壁与汇总静脉吻合方法；近年来15例采用经升主动脉和上腔静脉间，汇总静脉和左房顶部直接吻合的方法。结果 手术纠治TAPVC 87例，手术死亡6例，死亡率6.9%，其中心上型3例，心内型1例，心下型1例，混合型1例；远期死亡1例。结论 随着手术方法的改进，TAPVC纠治的成功率不断提高。对心内型，必须将剪去组织的心内膜对齐缝合，防止术后与关闭房缺的心包粘连。心上型手术，改为从左房顶部与汇总静脉直接吻合方法，手术效果满意。TAPVC一经诊断必须手术治疗，防止肺血管阻塞性病变的发生。 　　【关键词】 胸外科手术；肺静脉；体外循环；高血压，肺性 　　Surgical repair of total anomalous pulmonary venous connection 　　KONG De-ping,ZHA Guang-yan,LIU Jing-kui,et al.Department of Cardiovascular Surgery,Mudanjiang Cardiovascular Hospital,Mudanjiang 157011,China 　　【Abstract】 Objective To summarize and review the surgical repair of total anomalous pulmonary venous connection（TAPVC）.Methods From January 1988 to September 2005,87 patients were operated.The patients ages ranged from 4 months to 14 years,mean（2.98±3.6） years,and the weights were 4~28kg,mean（7.62±5.4）kg.51 patients belonged to the supracardiac type,28 intracardiac type,1 infracardiac type and 7 mixed type.6 cases of early periods TAPVC of the supracardiac type were repaired by lifting the heart;transverse incisions were made upon up to the right atrium and through the atrial septum to perform anastomosis between the left atrium and the common vein in 30 patients.Now we had repaired the anormaly from the superior anastomosis approach in 15 patients.Results 87 patients with TAPVC had been repaired.Six patients （3 supracardiac type,1 intracardiac type,1 infracardiac type and 1 mixed type）died and the mortality rate was 6.9%.There was one late death.Conclusion The operative result for TAPVC may be improved by early operation once the diagnosis is confirmed.The superior anastomosis approach is suitable for the supracardiac type,and appropriate intimal approximation of the edge of the enlarged coronary sinus is important to prevent adhe