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目的回顾完全性肺静脉异位引流(TAPVC)心下型的急诊手术经验和早中期随访结果。方法2000年9月至2003年6月,手术证实的4例心下型TAPVC,平均年龄27d。肺静脉回流的部位包括:门静脉2例,下腔静脉1例,另1例不详。3例临床上有肺静脉回流梗阻表现,所有患儿均行急诊手术。结果无手术死亡。1例术后合并肺炎,长时间呼吸机支持,术后19d自动出院。其余3例均痊愈出院。3例患儿得到随访,随访时间14个月~3年。2例恢复良好,心功能I级;1例术后4个月起出现肺静脉梗阻,仅作保守治疗但效果不理想,术后3年失访。结论心下型TAPVC病情危重,急症手术可挽救生命,手术早期效果良好。术后肺静脉梗阻一般内科治疗无效,应积极手术干预。
Objective To review the experience of emergency surgery and early-mid-term follow-up of subtropical type of complete pulmonary venous drainage (TAPVC). Methods From September 2000 to June 2003, 4 cases of subcardiac TAPVC confirmed by surgery were treated with mean age of 27 days. Pulmonary venous return sites include: 2 cases of portal vein, inferior vena cava in 1 case, the other 1 case unknown. 3 cases of clinical pulmonary venous obstruction performance, all children underwent emergency surgery. The result was no operative death. One patient had postoperative pneumonia and long-term ventilator support, and was discharged automatically 19 days after operation. The remaining 3 patients were discharged. Three patients were followed up for 14 months to 3 years. 2 cases recovered well, and I had heart function. One case had pulmonary vein obstruction 4 months after operation, which was only conservative treatment but the effect was not satisfactory. The patients lost their follow-up after 3 years. Conclusion Hypoxic subtype of TAPVC is critically ill, emergency surgery can save lives and the effect of early surgery is good. Postoperative pulmonary vein obstruction is generally ineffective medical treatment, surgical intervention should be positive.