摘要
目的总结功能性单心室合并下腔静脉与心尖同侧(ACJ)患者行全腔静脉-肺动脉吻合术(TCPC)的中远期疗效。方法回顾性分析2009年1月至2016年1月中国医学科学院阜外医院49例ACJ功能性单心室接受全腔静脉-肺动脉吻合术(TCPC)患者的临床资料。总结患者基本特征及术中、术后指标。结果49例患者中11例行内隧道TCPC,38例外管道TCPC(20例外管道绕心尖走形于心室后方,18例外管道横跨脊柱走行)。术后早期死亡1例,死亡率2.0%(1/49)。患者平均随访(44±33)个月,术后1年、5年、9年生存率分别为96.9%、93.3%、93.3%;术后1年、5年、9年内瓣膜免于中度及以上反流率分别为91.8%、88.4%、42.0%。远期2例患者存在管道内血栓形成,但是并未造成管道梗阻,所有患者均未出现外管道梗阻、肺静脉梗阻等原因需要再次手术的情况。结论TCPC可有效用于ACJ患者,具有良好的中远期生存率。但对于存在共同房室瓣的患者,远期瓣膜反流问题仍需手术解决。不论是经心尖心室后途径或横跨脊柱途径,远期外管道狭窄及肺静脉梗阻发生率均不高。
Objective To summarize the mid-long term curative effect of total cavopulmonary connection(TCPC)in functional singleventricle with apicocaval juxtaposition(ACJ)patients.Methods The clinical data of 49 functional single ventricular patients with ACJ who underwent TCPC in Fuwai Hospital,Chinese Academy of Medical Sciences from January 2009 to January 2016 were retrospectively analyzed.To summarize the basic characteristics of the patients and the intraoperative and postoperative indicators.Results Among the 49 patients,11 patients underwent intracardiac tunnel TCPC,38 patients underwent extracardiac conduct TCPC(20 patients conducts of which were behind the ventricle around the apex of the heart and 18 patients were across the spine).One case(2.0%)died in the early postoperative period.The average follow-up time of 49 patients was(44±33)months.The 1,5 and 9 years survival rates were 96.9%,93.3%,and 93.3%;the free rate of moderate and above valve regurgitation in 1,5 and 9 years after surgery was 91.8%,88.4%,and 42.0%,respectively.In the long term,two patients had thrombosis in the pipeline,but it did not cause obstruction of the pipeline.All patients did not have obstruction of the external pipeline,pulmonary vein obstruction and other reasons requiring reoperation.Conclusion TCPC can be effective in children with ACJ,and has a good mid-long term survival rate.However,for patients with common atrioventricular valves,the long-term valve regurgitation problem still needs to be solved by surgery;whether through the apical ventricular or transspine approach,the incidence of long-term external stenosis and pulmonary vein obstruction is not high.
作者
董硕
王菊
段亚冰
孙阳雪
杜楚豪
闫军
闫鹏
Dong Shuo;Wang Ju;Duan Yabing;Sun Yangxue;Du Chuhao;Yan Jun;Yan Peng(Department of Cardiac Surgery,Fuwai Hospital,Chinese Academy of Medical Sciences,Beijing 100037,China)
出处
《中国医药》
2020年第6期847-850,共4页
China Medicine
