本文選題：改良Fontan術式 + 肝靜脈直接入心房��； 參考：《北京協(xié)和醫(yī)學院》2017年碩士論文

【摘要】：目的:總結肝靜脈直接入心房(SHV)的(功能)單心室患者的改良Fontan術式及早中期臨床結果。方法:回顧性分析2009-01至2015-12阜外醫(yī)院對39例SHV的(功能)單心室患者施行改良Fontan術的臨床資料。男26例(66.7%),平均年齡(6.98±3.62)歲,平均體重(20.79±9.66)kg,術前平均肺動脈壓(mPAP)9.77±2.51(4～15)mmHg(1mmHg=(0.133kPa)。依據(jù)SHV患者是否合并下腔靜脈與心尖同側(ACJ),分為SHV組(n=29)和SHV+ACJ組(n=10)。對術后早期(3個月)及中期(5年)進行臨床結果分析。結果:兩組患兒的臨床資料比較差異無統(tǒng)計學意義(P0.05)。39例患者中,一期手術20例,二期手術19例(18例為Glenn術后,1例為B-T術后)。選擇的改良Fontan術式主要采取外管道—共同開口術式(30例,76.9%)。19例患兒常規(guī)建立體外循環(huán)并阻斷主動脈,體外轉流時間72～446 min,平均(189.74±84.96)min,主動脈阻斷 26～171 min,平均(89.05±43.96)min;19例患兒并行循環(huán),體外轉流時間60～209 min,平均(109.99±98.86)min;1例未用體外循環(huán)。術后早期因并發(fā)癥再次手術10例。術后早期死亡3例,死亡率7.7%。平均隨訪時間3.90(0.83～7.17)年,35例患兒心功能為Ⅰ級,1例為Ⅱ級;5年生存率100%。結論:SHV的(功能)單心室患者行改良Fontan術后早中期隨訪結果良好。而改良Fontan術式的選擇應依據(jù)下腔靜脈與肝靜脈間的距離以及是否合并 ACJ。
[Abstract]:Objective: to summarize the clinical results of modified Fontan procedure in patients with single ventricle. Methods: the clinical data of 39 patients with single ventricular (functional) SHV treated with modified Fontan from January 2009 to December 2015-12 in Fuwei Hospital were retrospectively analyzed. The mean age was 6.98 鹵3.62 years, the mean body weight was 20.79 鹵9.66 kg, and the preoperative mean pulmonary artery pressure was 9.77 鹵2.51 鹵2.51 鹵15mm Hg1 mm Hgn 0.133kPa.At the end of the study, the mean age was 6.98 鹵3.62, and the mean weight was 20.79 鹵9.66 kg / kg. Patients with SHV were divided into SHV group (n = 29) and SHV ACJ group (n = 10). The clinical results of early (3 months) and middle stage (5 years) after operation were analyzed. Results: there was no significant difference in clinical data between the two groups. Among the 39 cases, there were 20 cases of primary operation and 18 cases of secondary operation. One case was treated with B-T operation after Glenn. The modified Fontan operation was performed mainly by external conduit and common opening in 30 cases (76. 9 / 19). The CPB was established and the aorta was blocked in 19 cases. The CPB time was 72 ~ 446 min (mean 189.74 鹵84. 96 min), aortic occlusion was 26 ~ 171 min, and the average was 89. 05 鹵43. 96 min. The mean time of CPB was 109.99 鹵98.86 min in 1 case without CPB. Early postoperative complications occurred in 10 cases. Early postoperative death occurred in 3 cases and mortality was 7.7%. The mean follow-up time was 3.90 鹵0.837.17) the heart function of 35 children with cardiac function was grade 鈪，

本文編號：1851920