心上聯合徑路治療嬰幼兒心上型完全性肺靜脈異位引流 47 例_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

隋潤鈐 , 鐘京濤 , 訾捷 , 李德才 , 孫連功 , 譚琦 , 李清寶 ,  王安彪

山東大學附屬省立醫院（濟南 250021）;

Corresponding?author：

王安彪, Email: 313823871@qq.com

Keywords：

完全性肺靜脈異位引流; 先天性心臟病; 外科手術

DOI：

10.7507/1007-4848.201805059

Video：

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目的總結嬰幼兒心上型完全性肺靜脈異位引流的早期診斷和應用心上聯合徑路手術治療經驗。方法 2011 年 9 月至 2017 年 9 月，我院共完成 47 例嬰幼兒心上型完全性肺靜脈異位引流的手術治療，其中男 34 例、女 13 例，年齡 3 d～1 歲，平均年齡（3.5±2.6）個月，平均體質量 2.7～8.0（4.9±1.2）kg。患者均由超聲心動圖確診。所有患者均在全身麻醉中度低溫體外循環下行矯治術，均采用左心房頂部切口，心上聯合徑路行手術治療。結果全組手術順利，術后死亡 2 例，圍手術期死亡率 4.3%。隨訪 45 例，隨訪時間 6 個月～6 年，隨訪期均行心電圖、心臟超聲、胸部 X 線片檢查。所有患兒心電圖示竇性節律，心影較術前明顯縮小，肺充血消失，心功能明顯好轉，吻合口血流速度正常。結論嬰幼兒心上型完全性肺靜脈異位引流病情危重，早期診斷、心上聯合徑路手術效果良好。手術成功的關鍵在于吻合口足夠大，充分利用左心耳擴大吻合口，避免術后肺靜脈回流梗阻。

Citation： 隋潤鈐, 鐘京濤, 訾捷, 李德才, 孫連功, 譚琦, 李清寶, 王安彪. 心上聯合徑路治療嬰幼兒心上型完全性肺靜脈異位引流 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, 蘇肇伉, 主編. 現代小兒心臟外科學. 山東: 山東科學技術出版社, 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.	葛同開, 歐艷秋, 丁以群, 等. 心上型完全性肺靜脈異位引流手術 132 例的治療效果分析. 中國胸心血管外科臨床雜志, 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.	羅凱, 鄭景浩. 心上路徑矯治新生兒期完全性肺靜脈異位引流. 中國胸心血管外科臨床雜志, 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.	Sarita? 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.	李曉華, 莊建, 陳寄梅, 等. 新生兒完全性肺靜脈異位引流的矯治及預后相關危險因素分析. 中國胸心血管外科臨床雜志, 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.	邱家偉, 李巔遠. 完全型肺靜脈異位引流外科死亡的因素分析. 中國胸心血管外科臨床雜志, 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,歐艷秋,吳勇,等. 完全性肺靜脈異位引流患者術后流速和吻合口大小與早中期預后的關系. 嶺南心血管病雜志, 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, 蘇肇伉, 主編. 現代小兒心臟外科學. 山東: 山東科學技術出版社, 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. 葛同開, 歐艷秋, 丁以群, 等. 心上型完全性肺靜脈異位引流手術 132 例的治療效果分析. 中國胸心血管外科臨床雜志, 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. 羅凱, 鄭景浩. 心上路徑矯治新生兒期完全性肺靜脈異位引流. 中國胸心血管外科臨床雜志, 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. Sarita? 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. 李曉華, 莊建, 陳寄梅, 等. 新生兒完全性肺靜脈異位引流的矯治及預后相關危險因素分析. 中國胸心血管外科臨床雜志, 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. 邱家偉, 李巔遠. 完全型肺靜脈異位引流外科死亡的因素分析. 中國胸心血管外科臨床雜志, 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,歐艷秋,吳勇,等. 完全性肺靜脈異位引流患者術后流速和吻合口大小與早中期預后的關系. 嶺南心血管病雜志, 2016, 22(6): 673-677.

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心上聯合徑路治療嬰幼兒心上型完全性肺靜脈異位引流 47 例

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