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目的:探讨非体外循环下复杂先天性心脏病姑息手术适应证及处理要点。方法:2008-01-2010-06对26例复杂先天性心脏心病患儿实行非体外循环下姑息手术,其中肺动脉环缩术5例,改良体肺分流术6例,双向腔肺分流术14例,双向腔肺分流+改良体肺分流术1例;其中功能单心室9例,法洛四联症肺动脉闭锁6例,右室双出口4例,三尖瓣闭锁3例,完全性大动脉转位2例完全心内膜垫缺损并肺动脉闭锁1例,Ebstein畸形1例。结果:死亡4例,22例患者顺利出院,死亡率15.4%;死亡原因包括低氧血症及心功能衰竭、肺部感染合并心功能衰竭;肺动脉环缩术、改良体肺分流术、双向腔肺分流术后平均血氧饱和度分别为(81.8±2.4)%、(90.0±3.2)%、(86.4±4.1)%;术后并发症包括肺部感染3例,胸腔积液7例,上腔静脉综合征1例。术后随访2个月～1年,无远期死亡,心功能NYHAⅠ级7例,NYHAⅡ级15例。结论:非体外循环下姑息治疗是复杂先天性心脏病的有效治疗手段,特别适用于有体外循环高危因素患者,手术适应证的正确把握、术中术后合理的处理是降低死亡率的关键。
Objective: To investigate the indications and treatment points of palliative surgery for complex congenital heart disease without cardiopulmonary bypass. Methods: Twenty - six children with complicated congenital heart disease underwent off - pump palliative surgery. Among them, 5 cases were pulmonary vasoconstriction, 6 cases were modified pulmonary shunt and 14 cases were treated with bi - directional pulmonary shunt , Bi-directional luminal shunt + modified pulmonary shunt in 1 case; including 9 cases of single ventricle function, Tetralogy of Fallot pulmonary atresia in 6 cases, right ventricular double outlet in 4 cases, tricuspid atresia in 3 cases, complete aortic transposition 2 cases of complete endocardial cushion defect and pulmonary atresia in 1 case, Ebstein malformation in 1 case. Results: Four patients died and 22 patients were discharged smoothly with a mortality rate of 15.4%. The causes of death included hypoxemia and heart failure, pulmonary infection with heart failure, pulmonary artery shunt, modified pulmonary shunt, The average oxygen saturation after pulmonary shunt was (81.8 ± 2.4)%, (90.0 ± 3.2)% and (86.4 ± 4.1)% respectively. Complications included pulmonary infection in 3 and pleural effusion in 7 Vena Cava syndrome in 1 case. All the patients were followed up for 2 months to 1 year. There was no long-term mortality. NYHA class Ⅰ in 7 cases and NYHA Ⅱ class in 15 cases. CONCLUSION: Palliative treatment without cardiopulmonary bypass is an effective treatment for complicated congenital heart disease. It is especially suitable for patients with high risk of cardiopulmonary bypass. Correct grasp of surgical indications. Reasonable postoperative treatment is the key to reduce mortality.