心上联合径路治疗婴幼儿心上型完全性肺静脉异位引流 47 例_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

隋润钤 , 钟京涛 , 訾捷 , 李德才 , 孙连功 , 谭琦 , 李清宝 ,  王安彪

山东大学附属省立医院（济南 250021）;

Corresponding author：

王安彪, Email: 313823871@qq.com

Keywords：

完全性肺静脉异位引流; 先天性心脏病; 外科手术

DOI：

10.7507/1007-4848.201805059

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目的总结婴幼儿心上型完全性肺静脉异位引流的早期诊断和应用心上联合径路手术治疗经验。方法 2011 年 9 月至 2017 年 9 月，我院共完成 47 例婴幼儿心上型完全性肺静脉异位引流的手术治疗，其中男 34 例、女 13 例，年龄 3 d～1 岁，平均年龄（3.5±2.6）个月，平均体质量 2.7～8.0（4.9±1.2）kg。患者均由超声心动图确诊。所有患者均在全身麻醉中度低温体外循环下行矫治术，均采用左心房顶部切口，心上联合径路行手术治疗。结果全组手术顺利，术后死亡 2 例，围手术期死亡率 4.3%。随访 45 例，随访时间 6 个月～6 年，随访期均行心电图、心脏超声、胸部 X 线片检查。所有患儿心电图示窦性节律，心影较术前明显缩小，肺充血消失，心功能明显好转，吻合口血流速度正常。结论婴幼儿心上型完全性肺静脉异位引流病情危重，早期诊断、心上联合径路手术效果良好。手术成功的关键在于吻合口足够大，充分利用左心耳扩大吻合口，避免术后肺静脉回流梗阻。

Citation： 隋润钤, 钟京涛, 訾捷, 李德才, 孙连功, 谭琦, 李清宝, 王安彪. 心上联合径路治疗婴幼儿心上型完全性肺静脉异位引流 47 例. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(3): 297-300. doi: 10.7507/1007-4848.201805059 Copy

1.	Wyszynski DF, Graham TP, Correa-Villasenor A. Congenital Heart Defects from Origin to Treatment. New York: Oxford Universtiy Press, 2010. 181-185.
2.	Ando M, Takahashi Y, Kikuchi T. Total anomalous pulmonary venous connection with dysmorphic pulmonary vein: a risk for postoperative pulmonary venous obstruction. Interact Cardiovasc Thorac Surg, 2004, 3(4): 557-561.
3.	Jonas RA. Comprehensive Surgical Management of Congenital Heart Disease. London: Arnold, 2004. 402-413.
4.	Agematsu K, Okamura T, Takiguchi Y, et al. Pulmonary vein obstruction after primary sutureless pericardial repair of a total anomalous pulmonary venous connection. Interact Cardiovasc Thorac Surg, 2018, [Epub ahead of print].
5.	丁文祥, 苏肇伉, 主编. 现代小儿心脏外科学. 山东: 山东科学技术出版社, 2013. 591-596.
6.	St Louis JD, Harvey BA, Menk JS, et al. Repair of " simple” total anomalous pulmonary venous connection: a review from the Pediatric Cardiac Care Consortium. Ann Thorac Surg, 2012, 94(1): 133-137.
7.	Mainwaring RD, Reddy VM, Reinhartz O, et al. Surgical results in patients with pulmonary atresia-major aortopulmonary collaterals in association with total anomalous pulmonary venous connection. Ann Thorac Surg, 2011, 92(5): 1756-1760.
8.	Kimura N, Masuoka A, Katogi T, et al. A simplified technique for total anomalous pulmonary venous connection repair associated with functional single ventricle. J Thorac Cardiovasc Surg, 2012, 143(6): 1455-1457.
9.	葛同开, 欧艳秋, 丁以群, 等. 心上型完全性肺静脉异位引流手术 132 例的治疗效果分析. 中国胸心血管外科临床杂志, 2014, 21(6): 774-778.
10.	Kelle AM, Backer CL, Gossett JG, et al. Total anomalous pulmonary venous connection. Results of surgical repair of 100 patients at a single institution. J Thorac Cardiovasc Surg, 2010, 139(6): 1387-1394.
11.	Karamlou T, Gurofsky R, Al Sukhni E, et al. Factors associated with mortality and reoperation in 377 children with total anomalous pulmonary venous connection. Circulation, 2007, 115(12): 1591-1598.
12.	Tucker BL, Lindesmith GG, Stiles QR, et al. The superior approach for correction of the supracardiac type of total anomalous pulmonary venous return. Ann Thorac Surg, 1976, 22(4): 374-377.
13.	Okonta KE, Agarwal V, Abubakar U. Superior repair: A useful approach for some anatomic variants of total anomalous pulmonary venous connection. Afr J Paediatr Surg, 2013, 10(2): 131-134.
14.	罗凯, 郑景浩. 心上路径矫治新生儿期完全性肺静脉异位引流. 中国胸心血管外科临床杂志, 2015, 22(2): 165-167.
15.	Douglas YL, Jongbloed MR, den Hartog WC, et al. Pulmonary vein and atrial wall pathology in human total anomalous pulmonary venous connection. Int J Cardiol, 2009, 134(3): 302-312.
16.	Saritaş B, Celik M, Tatar T, et al. The outcome of the vertical vein left intact during the surgery for total anomalous venous connection and its effects on ventricular functions. Anadolu Kardiyol Derg, 2011, 11(7): 638-642.
17.	Hote MP, Garg S, Choudhury M, et al. Open vertical vein in non-obstructed supracardiac TAPVC: merits and fate. Asian Cardiovasc Thorac Ann, 2012, 20(2): 114-119.
18.	李晓华, 庄建, 陈寄梅, 等. 新生儿完全性肺静脉异位引流的矫治及预后相关危险因素分析. 中国胸心血管外科临床杂志, 2015, 22(12): 1138-1142.
19.	Hoashi T, Kagisaki K, Kurosaki K, et al. Intrinsic obstruction in pulmonary venous drainage pathway is associated with poor surgical outcomes in patients with total anomalous pulmonary venous connection. Pediatr Cardiol, 2015, 36(2): 432-437.
20.	Yamashita K, Hoashi T, Kagisaki K, et al. Midterm outcomes of sutureless technique for postoperative pulmonary venous stenosis. Gen Thorac Cardiovasc Surg, 2014, 62(1): 48-52.
21.	邱家伟, 李巅远. 完全型肺静脉异位引流外科死亡的因素分析. 中国胸心血管外科临床杂志, 2014, 21(6): 817-821.
22.	Yanagawa B, Alghamdi AA, Dragulescu A, et al. Primary sutureless repair for " simple” total anomalous pulmonary venous connection: midterm results in a single institution. J Thorac Cardiovasc Surg, 2011, 141(6): 1346-1354.
23.	高向民,欧艳秋,吴勇,等. 完全性肺静脉异位引流患者术后流速和吻合口大小与早中期预后的关系. 岭南心血管病杂志, 2016, 22(6): 673-677.

1. Wyszynski DF, Graham TP, Correa-Villasenor A. Congenital Heart Defects from Origin to Treatment. New York: Oxford Universtiy Press, 2010. 181-185.
2. Ando M, Takahashi Y, Kikuchi T. Total anomalous pulmonary venous connection with dysmorphic pulmonary vein: a risk for postoperative pulmonary venous obstruction. Interact Cardiovasc Thorac Surg, 2004, 3(4): 557-561.
3. Jonas RA. Comprehensive Surgical Management of Congenital Heart Disease. London: Arnold, 2004. 402-413.
4. Agematsu K, Okamura T, Takiguchi Y, et al. Pulmonary vein obstruction after primary sutureless pericardial repair of a total anomalous pulmonary venous connection. Interact Cardiovasc Thorac Surg, 2018, [Epub ahead of print].
5. 丁文祥, 苏肇伉, 主编. 现代小儿心脏外科学. 山东: 山东科学技术出版社, 2013. 591-596.
6. St Louis JD, Harvey BA, Menk JS, et al. Repair of " simple” total anomalous pulmonary venous connection: a review from the Pediatric Cardiac Care Consortium. Ann Thorac Surg, 2012, 94(1): 133-137.
7. Mainwaring RD, Reddy VM, Reinhartz O, et al. Surgical results in patients with pulmonary atresia-major aortopulmonary collaterals in association with total anomalous pulmonary venous connection. Ann Thorac Surg, 2011, 92(5): 1756-1760.
8. Kimura N, Masuoka A, Katogi T, et al. A simplified technique for total anomalous pulmonary venous connection repair associated with functional single ventricle. J Thorac Cardiovasc Surg, 2012, 143(6): 1455-1457.
9. 葛同开, 欧艳秋, 丁以群, 等. 心上型完全性肺静脉异位引流手术 132 例的治疗效果分析. 中国胸心血管外科临床杂志, 2014, 21(6): 774-778.
10. Kelle AM, Backer CL, Gossett JG, et al. Total anomalous pulmonary venous connection. Results of surgical repair of 100 patients at a single institution. J Thorac Cardiovasc Surg, 2010, 139(6): 1387-1394.
11. Karamlou T, Gurofsky R, Al Sukhni E, et al. Factors associated with mortality and reoperation in 377 children with total anomalous pulmonary venous connection. Circulation, 2007, 115(12): 1591-1598.
12. Tucker BL, Lindesmith GG, Stiles QR, et al. The superior approach for correction of the supracardiac type of total anomalous pulmonary venous return. Ann Thorac Surg, 1976, 22(4): 374-377.
13. Okonta KE, Agarwal V, Abubakar U. Superior repair: A useful approach for some anatomic variants of total anomalous pulmonary venous connection. Afr J Paediatr Surg, 2013, 10(2): 131-134.
14. 罗凯, 郑景浩. 心上路径矫治新生儿期完全性肺静脉异位引流. 中国胸心血管外科临床杂志, 2015, 22(2): 165-167.
15. Douglas YL, Jongbloed MR, den Hartog WC, et al. Pulmonary vein and atrial wall pathology in human total anomalous pulmonary venous connection. Int J Cardiol, 2009, 134(3): 302-312.
16. Saritaş B, Celik M, Tatar T, et al. The outcome of the vertical vein left intact during the surgery for total anomalous venous connection and its effects on ventricular functions. Anadolu Kardiyol Derg, 2011, 11(7): 638-642.
17. Hote MP, Garg S, Choudhury M, et al. Open vertical vein in non-obstructed supracardiac TAPVC: merits and fate. Asian Cardiovasc Thorac Ann, 2012, 20(2): 114-119.
18. 李晓华, 庄建, 陈寄梅, 等. 新生儿完全性肺静脉异位引流的矫治及预后相关危险因素分析. 中国胸心血管外科临床杂志, 2015, 22(12): 1138-1142.
19. Hoashi T, Kagisaki K, Kurosaki K, et al. Intrinsic obstruction in pulmonary venous drainage pathway is associated with poor surgical outcomes in patients with total anomalous pulmonary venous connection. Pediatr Cardiol, 2015, 36(2): 432-437.
20. Yamashita K, Hoashi T, Kagisaki K, et al. Midterm outcomes of sutureless technique for postoperative pulmonary venous stenosis. Gen Thorac Cardiovasc Surg, 2014, 62(1): 48-52.
21. 邱家伟, 李巅远. 完全型肺静脉异位引流外科死亡的因素分析. 中国胸心血管外科临床杂志, 2014, 21(6): 817-821.
22. Yanagawa B, Alghamdi AA, Dragulescu A, et al. Primary sutureless repair for " simple” total anomalous pulmonary venous connection: midterm results in a single institution. J Thorac Cardiovasc Surg, 2011, 141(6): 1346-1354.
23. 高向民,欧艳秋,吴勇,等. 完全性肺静脉异位引流患者术后流速和吻合口大小与早中期预后的关系. 岭南心血管病杂志, 2016, 22(6): 673-677.

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心上联合径路治疗婴幼儿心上型完全性肺静脉异位引流 47 例

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