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目的评价双侧体-肺分流对左、右肺动脉融合部狭窄或闭锁的发绀型先天性心脏病的临床疗效。方法 30例复杂先天性心脏病患儿,肺动脉闭锁26例,肺动脉狭窄4例(右心室双出口2例、法洛四联征及功能单心室各1例);合并体-肺侧支形成4例,内脏异位3例。根据患儿两侧肺动脉发育、肺动脉开口狭窄情况,行双侧改良B-T分流术2例,双侧中心分流术13例,右侧改良B-T+左侧中心分流术8例,右侧中心分流+左侧改良B-T分流术7例。结果术后因严重低氧血症死亡1例;并发低心排出量综合征3例,灌注肺2例,严重肺部感染1例;术后左、右肺动脉指数((101±80)、(97±51)mm2/M2)及动脉血氧饱和度((83±6)%)均较术前((38±28)、(45±25)mm2/M2,(62±13)%)提高,血红蛋白水平((178±30)g/L)较术前((194±29)g/L)下降,手术前、后比较差异有统计学意义(P<0.01);随访18~52个月,8例完成格林手术,3例完成Fontan手术,3例完成根治手术。结论双侧体-肺分流手术可有效促进患儿左、右肺动脉发育,改善发绀,治疗左、右肺动脉开口狭窄或闭锁的发绀型复杂先天性心脏病疗效满意。
Objective To evaluate the clinical efficacy of bilateral body-lung shunt on the narrowing or occlusion of cyanotic congenital heart disease in the left and right pulmonary artery fusion. Methods Thirty patients with complex congenital heart disease underwent pulmonary atresia in 26 cases, pulmonary stenosis in 4 cases (right ventricular double outlet in 2 cases, tetralogy of Fallot and single function ventricular in 1 case) Cases, 3 cases of visceral ectopic. According to the development of pulmonary artery on both sides of children with pulmonary stenosis, two cases of bilateral modified BT shunt, bilateral central shunt in 13 cases, right modified B-T + left central shunt in 8 cases, right central shunt + Left modified BT shunt in 7 cases. Results One patient died of severe hypoxemia after operation. There were 3 patients with low cardiac output syndrome, 2 lung perfusion and 1 severe pulmonary infection. The left and right pulmonary artery index ((101 ± 80), ( 97 ± 51 mm2 / M2) and arterial oxygen saturation (83 ± 6%) were significantly higher than those of preoperative (38 ± 28), (45 ± 25) mm2 / M2, (62 ± 13)%) , Hemoglobin level (178 ± 30) g / L was significantly lower than that before operation ((194 ± 29) g / L), and the difference was statistically significant before and after operation (P <0.01) , 8 cases completed Green operation, 3 cases completed Fontan operation and 3 cases completed radical operation. Conclusions Bilateral shunt for pulmonary shunt can effectively promote left and right pulmonary artery development, improve cyanosis and treat cyanotic complex congenital heart disease with left or right pulmonary artery stenosis or occlusion.