【摘要】：目的:總結(jié)完全性肺靜脈異位引流(TAPVC)矯治術(shù)后肺靜脈梗阻的治療經(jīng)驗(yàn)。方法:回顧性分析2011-01至2015-12于青島市婦女兒童醫(yī)院心臟中心施行TAPVC矯治術(shù)后發(fā)生肺靜脈梗阻16例患兒的臨床資料,其中男性10例。所有患兒均出院前、術(shù)后1個(gè)月、3個(gè)月、6個(gè)月、12個(gè)月、24個(gè)月回院復(fù)診,包括經(jīng)胸心臟超聲多普勒、心電圖、X線胸部正側(cè)位片。以經(jīng)胸心臟超聲多普勒檢查肺靜脈流速2 m/s為梗阻標(biāo)準(zhǔn),診斷肺靜脈梗阻。結(jié)合患兒臨床表現(xiàn)(反復(fù)心力衰竭、生長(zhǎng)發(fā)育遲緩)確定二次手術(shù)時(shí)機(jī)。二次手術(shù)采用sutureless縫合技術(shù)和常規(guī)補(bǔ)片擴(kuò)大技術(shù)。結(jié)果:術(shù)后發(fā)生肺靜脈狹窄16例患兒無失訪,其中7例吻合口周圍狹窄(混合型1例,心下型3例,心上型2例,心內(nèi)型1例);7例單支肺靜脈狹窄,2例雙支肺靜脈狹窄,無三支及以上肺靜脈狹窄。按術(shù)前Darling類型分:混合型2例,心下型5例,心上型5例,心內(nèi)型4例。11例(68.8%)術(shù)后肺靜脈狹窄流速增快發(fā)生在術(shù)后3~6個(gè)月。5例二次手術(shù)患兒中,4例采用sutureless縫合技術(shù),1例采用常規(guī)補(bǔ)片擴(kuò)大技術(shù),均為吻合口周圍梗阻狹窄,2例死亡,3例患兒隨訪中。結(jié)論:TAPVC矯治術(shù)后吻合口周圍狹窄為主要二次手術(shù)適應(yīng)證,并且需早期即行手術(shù)。
[Abstract]:Objective: to summarize the experience of complete anomalous pulmonary venous drainage (TAPVC) in the treatment of postoperative pulmonary vein obstruction. Methods: the clinical data of 16 children with pulmonary vein obstruction after TAPVC correction from January 2011 to December 2015-12 in heart center of Qingdao Women and Children's Hospital were analyzed retrospectively, including 10 cases of male. All the children were returned to hospital 1 month, 3 months, 6 months, 12 months and 24 months before discharge, including transthoracic echocardiography, electrocardiogram X ray chest positive and lateral radiography. Pulmonary venous obstruction was diagnosed by transthoracic echocardiographic Doppler flow velocity of 2 m / s. Combined with clinical manifestations (recurrent heart failure, growth retardation) to determine the opportunity of secondary surgery. The secondary operation was performed with sutureless suture technique and conventional patch expansion technique. Results: there were 16 cases of pulmonary vein stenosis after operation. Among them, 7 cases had stenosis around anastomotic stoma (mixed type 1 case, subcardiac type 3 cases, supracardiac type 2 cases, intracardiac type 1 case) and single pulmonary vein stenosis (2 cases) and double pulmonary vein stenosis (2 cases). There was no stenosis of three or more pulmonary veins. According to the type of Darling before operation, there were 2 cases of mixed type, 5 cases of subcardiac type and 5 cases of supracardiac type. In 4 cases (68.8%) of intracardiac type, the increase of velocity of pulmonary vein stenosis occurred in 4 cases (68.8%) of whom 4 cases were treated with sutureless suture technique, and 1 case was treated with conventional patching expansion technique in 4 out of 5 cases of secondary operation at 3 ~ 6 months after operation. All patients were followed up for 2 children with stenosis around the anastomotic stoma. Conclusion the main indication of secondary operation is the treatment of perianastomotic stricture with the use of% TAPVC, and it is necessary to perform early operation.
【作者單位】： 青島市婦女兒童醫(yī)院青島大學(xué)附屬青島婦女兒童醫(yī)院心臟中心青島大學(xué)先心病研究中心;
【分類號(hào)】：R726.5
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本文編號(hào)：2226175