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目的总结心内隧道全腔静脉肺动脉连接术治疗小儿复杂先天性心脏病的效果。方法复杂性先天性心脏病患儿11例,均在全身中度低温、局部心脏低温、体外循环心脏停跳下手术;先充分游离上下腔静脉,以利插管建立体外循环,充分游离主肺动脉、左肺动脉及右肺动脉直达肺门,以利切断后吻合时减少吻合口张力。上腔静脉入右房处上方1 cm处横断,远心端与右肺动脉上缘端侧吻合,Gore-Tex人工血管壁的2/3与右房壁连接上下腔静脉口形成心内隧道,上腔静脉近心端与主肺动脉吻合;如果吻合口前壁有张力,采用自体心包片延长,存在左上腔静脉者与左肺动脉侧侧吻合。结果全组患儿无手术死亡,4例术后出现胸腔积液,经反复穿刺抽液及胸腔闭式引流治愈,末梢血氧饱和度96%～99%,术后心功能Ⅰ、Ⅱ级,无心律失常发生。结论心内隧道全腔静脉肺动脉连接术是治疗小儿复杂先天性心脏病切实可行的方法,优于双向Glenn手术,可避免患儿二次手术。
Objective To summarize the effect of intracardiac tunneling with total cavopulmonary connection in the treatment of complex congenital heart disease in children. Method complexity 11 cases of congenital heart disease in children, are moderate hypothermia, local hypothermia, cardiopulmonary bypass cardiopulmonary bypass surgery; full free upper and lower vena cava, to facilitate the establishment of cardiopulmonary bypass intubation, full free of the main pulmonary artery , Left pulmonary artery and right pulmonary artery directly to the hilar and to reduce the anastomosis tension after anastomosis. Superior vena cava into the right atrium at 1 cm transverse transection, the distal end of the right pulmonary artery anastomosis, Gore-Tex artificial blood vessel wall 2/3 and the right atrial wall connected to the inferior vena cava to form a cardiac tunnel, the upper Near the end of the vena cava and the main pulmonary artery anastomosis; if the anterior wall of the anastomosis tension, the use of autologous pericardium extended, there is the left superior vena cava and left pulmonary artery anastomosis. Results There was no operative death in all the cases. Pleural effusion was found in 4 cases. Repeated puncture fluid drainage and closed thoracic drainage were used. Surgical oxygen saturation was 96% -99%, postoperative cardiac function Ⅰ, Ⅱ, No arrhythmia occurred. Conclusion Intra-heart tunnel total-vena cava pulmonary artery connection is a feasible and feasible method for the treatment of complicated congenital heart disease in children. It is superior to bi-directional Glenn operation in avoiding secondary surgery in children.