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目的 总结完全性大动脉错位 (D -TGA)二期手术治疗效果和经验。方法 回顾分析1990年 8月至 2 0 0 0年 12月间 8例进行二期手术D TGA病儿。二期手术年龄为 14d～ 96个月 ,平均(5 0 5± 32 4 )个月 ;体重为 3 7～ 2 3 5kg ,平均 (15 9± 6 1)kg。两次手术间隔时间为 3d～ 75个月。初期手术中球囊房间隔缺损扩张术 2例 ,伴肺动脉发育不良行Blalock Taussig分流术 2例 ;因肺动脉高压行肺动脉环缩术 (PAB) 4例。二期手术中Senning手术 1例 ,Rastelli手术 4例 ,大动脉转换术 (ASO) 2例 ,改良Fontan手术 1例。结果 手术早期死亡 2例 ,1例为Rastelli手术 ,另 1例为改良Fontan手术 ,死亡原因分别为器质性肺动脉高压和左室流出道梗阻。早期生存 6例 ,随访发现 ,Senning手术病儿三尖瓣轻度反流 ,心胸比率 0 6 ;3例Rastelli手术者无左、右室流出道梗阻 ,心功能良好 ,III度房室传导阻滞 1例 ,完全性右束支传导阻滞 2例 ;ASO 2例均无解剖问题 ,心功能正常 ,远期效果满意。结论 初期姑息手术可以对完全大动脉错位病儿的生理进行初步“调整”或“准备” ;二期手术尽量选择大动脉转换术 ,由于解剖或生理因素可选择Rastelli手术或Senning手术 ,避免改良Fontan手术。
Objective To summarize the results and experience of the second phase surgery of complete aortic dislocation (D-TGA). Methods Retrospective analysis of eight cases from August 1990 to December 2000 surgery for the second surgery D TGA sick children. The second stage of operation was from 14 days to 96 months, with an average of (54 ± 32 4) months. The body weight was 37 to 225kg, with an average of (15 9 ± 6 1) kg. The interval between two operations is 3d ~ 75 months. In the initial operation, 2 cases of atrial septal defect were expanded, Blalock Taussig shunt was performed in 2 cases with pulmonary dysplasia, and 4 cases of pulmonary arterial ring contraction (PAB) due to pulmonary hypertension. Two cases of Senning operation in 1 case, Rastelli operation in 4 cases, aortic conversion (ASO) in 2 cases, modified Fontan operation in 1 case. Results In the early stage of operation, there were 2 deaths, 1 case was Rastelli operation and 1 case was modified Fontan operation. The causes of death were organic pulmonary hypertension and left ventricular outflow tract obstruction. Early survival in 6 cases, follow-up found that children with Senning surgery mild tricuspid regurgitation, cardiothoracic ratio of 6; 3 cases of Rastelli surgery without left and right ventricular outflow tract obstruction, cardiac function, III degree atrioventricular block 1 case, complete right bundle branch block in 2 cases; ASO 2 cases without anatomical problems, normal heart function, long-term results were satisfactory. Conclusions Early palliative surgery can initially “adjust” or “prepare” the physiology of infants with complete arteriolar dislocation. In the second stage, the aorta should be chosen as the best choice of aortic transposition. Because of anatomical or physiological factors, Rastelli operation or Senning operation may be selected to avoid modified Fontan operation.