完全性肺静脉异位引流矫治术后肺静脉梗阻的治疗探讨
发布时间：2018-09-06 11:11
【摘要】：目的:总结完全性肺静脉异位引流(TAPVC)矫治术后肺静脉梗阻的治疗经验。方法:回顾性分析2011-01至2015-12于青岛市妇女儿童医院心脏中心施行TAPVC矫治术后发生肺静脉梗阻16例患儿的临床资料,其中男性10例。所有患儿均出院前、术后1个月、3个月、6个月、12个月、24个月回院复诊,包括经胸心脏超声多普勒、心电图、X线胸部正侧位片。以经胸心脏超声多普勒检查肺静脉流速2 m/s为梗阻标准,诊断肺静脉梗阻。结合患儿临床表现(反复心力衰竭、生长发育迟缓)确定二次手术时机。二次手术采用sutureless缝合技术和常规补片扩大技术。结果:术后发生肺静脉狭窄16例患儿无失访,其中7例吻合口周围狭窄(混合型1例,心下型3例,心上型2例,心内型1例);7例单支肺静脉狭窄,2例双支肺静脉狭窄,无三支及以上肺静脉狭窄。按术前Darling类型分:混合型2例,心下型5例,心上型5例,心内型4例。11例(68.8%)术后肺静脉狭窄流速增快发生在术后3~6个月。5例二次手术患儿中,4例采用sutureless缝合技术,1例采用常规补片扩大技术,均为吻合口周围梗阻狭窄,2例死亡,3例患儿随访中。结论:TAPVC矫治术后吻合口周围狭窄为主要二次手术适应证,并且需早期即行手术。
[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.
【作者单位】： 青岛市妇女儿童医院青岛大学附属青岛妇女儿童医院心脏中心青岛大学先心病研究中心;
【分类号】：R726.5
，
本文编号：2226175
[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.
【作者单位】： 青岛市妇女儿童医院青岛大学附属青岛妇女儿童医院心脏中心青岛大学先心病研究中心;
【分类号】：R726.5
，
本文编号：2226175
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