下腔静脉引流异常的（功能）单心室患者的改良Fontan术式及早中期疗效

发布时间：2018-05-06 10:18

  本文选题：改良Fontan术式 + 肝静脉直接入心房　； 参考：《北京协和医学院》2017年硕士论文

【摘要】：目的:总结肝静脉直接入心房(SHV)的(功能)单心室患者的改良Fontan术式及早中期临床结果。方法:回顾性分析2009-01至2015-12阜外医院对39例SHV的(功能)单心室患者施行改良Fontan术的临床资料。男26例(66.7%),平均年龄(6.98±3.62)岁,平均体重(20.79±9.66)kg,术前平均肺动脉压(mPAP)9.77±2.51(4～15)mmHg(1mmHg=(0.133kPa)。依据SHV患者是否合并下腔静脉与心尖同侧(ACJ),分为SHV组(n=29)和SHV+ACJ组(n=10)。对术后早期(3个月)及中期(5年)进行临床结果分析。结果:两组患儿的临床资料比较差异无统计学意义(P0.05)。39例患者中,一期手术20例,二期手术19例(18例为Glenn术后,1例为B-T术后)。选择的改良Fontan术式主要采取外管道—共同开口术式(30例,76.9%)。19例患儿常规建立体外循环并阻断主动脉,体外转流时间72～446 min,平均(189.74±84.96)min,主动脉阻断 26～171 min,平均(89.05±43.96)min;19例患儿并行循环,体外转流时间60～209 min,平均(109.99±98.86)min;1例未用体外循环。术后早期因并发症再次手术10例。术后早期死亡3例,死亡率7.7%。平均随访时间3.90(0.83～7.17)年,35例患儿心功能为Ⅰ级,1例为Ⅱ级;5年生存率100%。结论:SHV的(功能)单心室患者行改良Fontan术后早中期随访结果良好。而改良Fontan术式的选择应依据下腔静脉与肝静脉间的距离以及是否合并 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 卤3.62 years, the mean body weight was 20.79 卤9.66 kg, and the preoperative mean pulmonary artery pressure was 9.77 卤2.51 卤2.51 卤15mm Hg1 mm Hgn 0.133kPa.At the end of the study, the mean age was 6.98 卤3.62, and the mean weight was 20.79 卤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 卤84. 96 min), aortic occlusion was 26 ~ 171 min, and the average was 89. 05 卤43. 96 min. The mean time of CPB was 109.99 卤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 卤0.837.17) the heart function of 35 children with cardiac function was grade 鈪，

本文编号：1851920