摘要
目的：对比观察不同方法矫治完全性心内膜垫缺损（TECD）的临床经验和效果.方法：2010年4月至2012年10月,一期矫治TECD患者48例（男性15例,女性33例）,中位年龄0.9（3个月～ 22岁）,中位体质量7.9（4.8 ～47） kg.心内畸形按Rastelli分型：A型38例、B型2例及C型8例.48例患者中10例合并Down综合征,其它合并畸形包括继发孔型房间隔缺损20例,动脉导管未闭7例,完全性肺静脉畸形引流1例,法洛四联症1例,肺动脉狭窄2例,永存左上腔静脉6例.超声心动图观察术前共同房、室瓣反流程度为轻度18例,中度25例,重度5例.4例因重度肺高压于根治术前曾行肺动脉环缩术.结果：48例一期矫治患者中,采用改良单片法16例,双片法32例.平均体外循环时间（128.4±39.5）min,阻断循环时间（89.4±29.5）min.术后机械通气中位时间42.0 h,ICU驻留中位时间4.5d；住院中位时间11.0d.1例早期死亡（病死率为2.2％）,死因为低心排出量综合征（低心排）.其他并发症包括室间隔缺损（VSD）残余分流4例,Ⅲ.房室传导阻滞1例,二尖瓣中度反流2例,三尖瓣中度反流3例.另1例因左侧房室瓣大量反流和1例因房间隔补片撕裂,致严重低氧血症而于围术期分别行再次手术,其余均顺利出院.存活47例患儿获定期随访,随访时间3～ 32个月.中期随访结果显示4例合并二尖瓣中度反流,3例三尖瓣中度反流,其余无或仅轻微量瓣膜反流,4例仍有小的VSD残余分流.结论：目前随着外科技术的不断提高和围术期处理经验的不断成熟,一期矫治TECD患儿通常可以取得良好的临床效果,且手术风险低,近中期效果好.
Objective：To evaluates the clinical experience and outcomes of surgical repair of complete atrioventricular septal defect （TECD） with a two-patch and modify one-patch technique. Methods： 48 patients with complete TECD undergoing complete repair with a two-patch or modified one-patch technique were re- viewed between April 2010 and October 2012. The age of these patients at operation was 0. 9 years （range, from 3 months to 22 years）. The weight of these patients was 7. 9 kg（ range, from 4. 8 to 47 kg）. The morpho- logical types included Rastelli A in 29, Rastelli B in 2, Rastelle C in 8 and intermediate type in 9 patients. 10 patients had Down syndrome. Other complicated abnormalities included seeundum atrial septal defect or single atrium in 20, patent ductus arteriosus in 7, pulmonary stenosis in 2, TAPVC in 1 and tetralogy of fallot in 1 pa- tient. All patients underwent preoperative chest X-ray, electrocardiogram and echocardiogram. According to the results of echocardiography, the common atrioventricular valve regurgitation was mild in 18 cases, moderate in 25 cases and severe in 5 cases. All patients reiceived preoperative inotropic and diuretic treatment for 2 to 4 weeks and after that underwent a complete surgical correction. Results： 16 patients were performed one-patch or modified one-patch technique and other 32 patients were performed two-patch technique. The CPB time was（ 128.4 ± 39. 5 ） rain, the mean occluding time was （ 89.4± 29. 5 ） min. The duration of mechanical ventilation time was 42 hours and ICU time was 4. 5. The time in hospital was 11 days. One patient died of low cardiac output syndrome（ the mortality rate was 2. 2% ）. Other complications included residual VSD in 4 cases, com- plete atrioventricular block in 1 case, moderate mitral valve regurgitation in 2 cases and moderate tricuspid valve regurgitation in 3 cases. The survived 47 patients were regularly followed up for 3 to 32 months. It showed that the medium-term results was satisfying except that ther
出处
《心肺血管病杂志》
CAS
2013年第6期671-674,共4页
Journal of Cardiovascular and Pulmonary Diseases
关键词
先天性心脏病
完全性心内膜垫缺损
改良单片法
双片法
Congenital heart disease
Complete endocardial cushion defect
Modified one-patch tech-nique
Two-patch technique
