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目的 总结治疗纠正型大动脉错位的手术方法和经验。方法 1990年 1月～ 1998年12月 ,手术治疗纠正型大动脉错位 (C TGA) 31例 (占同期手术 0 .6 % )。男性 2 1例 ,女性 10例。手术年龄 2～ 9岁 (平均 5 .2 8± 1.76岁 ) ,体重 7～ 2 2 .5kg(平均 15 .96± 3.78kg)。其中伴左室流出道梗阻2 7例 ,肺动脉高压 4例。 2 4例做双心室修补术 ,其中 12例经形态左心室切口修补室缺 ,死亡 3例 ;12例经形态右心室切口修补室缺 ,死亡 1例。Fontan纠治手术 5例 ,死亡 1例。双向腔肺动脉吻合术 2例 ,无死亡。结果 全组手术死亡率 16.1%。长期随访的疗效不理想 ,主要形态右心室不能长期耐受体循环压力 ,易发生三尖瓣反流。结论 C TGA伴肺动脉高压 ,必须在 1岁以内早期手术。目前双心室手术方法的远期结果尚不理想 ,应以解剖纠治方法为好。
Objective To summarize the surgical methods and experience in the treatment of malocclusive aorta. Methods From January 1990 to December 1998, 31 cases of corrected TGA (C TGA) were treated surgically (accounting for 0.6% of the same period). There were 21 males and 10 females. The operative age ranged from 2 to 9 years (mean, mean, 5.22 ± 1.76 years), and body weight ranged from 7 to 225.5 kg (average 15.96 ± 3.78 kg). Of which 27 cases with left ventricular outflow tract obstruction, 4 cases of pulmonary hypertension. In 24 cases, biventricular repairs were performed. Among them, 12 cases were left ventricular remodeling in 3 cases, and 3 cases died. Twelve cases were repaired through right ventricular incision and 1 died. Fontan correction surgery in 5 cases, 1 died. Two-way pulmonary artery anastomosis in 2 cases, no death. Results The overall surgical mortality rate was 16.1%. Long-term follow-up of the efficacy is not satisfactory, the main form of the right ventricle can not tolerate long-term systemic pressure, prone to tricuspid regurgitation. Conclusion C TGA with pulmonary hypertension must be operated within 1 year of age. At present, the long-term results of biventricular surgery are not satisfactory, and the method of anatomy and correction should be used as well.