完全性房室通道的外科治疗.docVIP

完全性房室通道的外科治疗 邓 盛 刘邕波 白 韬 广西壮族自治区第二人民医院胸心外科，桂林 541002 [摘要] 目的 总结我院近年来手术治疗完全性房室通道的经验。方法 我院自2003年1月至2008年12月共手术治疗完全性房室通道44例。男27例，女17例。年龄4个月～12岁，1岁以下8例。体重5—21 Kg，平均8.7 Kg。Rastelli分型：A型43例（其中过渡型17例），B型1例。合并畸形包括：法洛氏四联症2例，动脉导管未闭6例，右室流出道狭窄2例，永存左上腔4例。手术在浅中低温体外循环下进行。采用戊二醛处理的自体心包补片连续缝合修补间隔缺损，单片法6例，双片法21例。17例过渡型采用直接下压共瓣修补室缺，间断缝合二、三尖瓣瓣裂，反复注水测试二尖瓣关闭情况直至满意。冠状静脉窦区采用浅缝合，冠状静脉窦开口留在右房。结果 手术死亡1例，术后死亡2例，术后早期发生Ⅲ0 AVB 5例，4例经治疗在术后3周恢复窦性心律，1例安装永久起搏器。存活病例术后随访5个月—6年，症状消失，生长发育良好，心功能均＜Ⅱ级，2例失访。术后Echo检查显示二尖瓣轻度返流8例，中度返流2例，残余室间隔缺损4例，均在半年后自愈。 结论 完全性房室通道的患儿在诊断明确后应尽早争取在6个月内行根治性手术，同时尽量完善修复二、三尖瓣裂，会取得良好的效果。 [关键词] 完全性房室通道；体外循环；外科治疗 Surgical Treatment of Complete Atrioventricular Canal Defect DENG Sheng,LIU Yong Bo,Bai Tao.Department of Cardiovascular Surgery,Guangxi 2st people,s hospital,Guilin 541002,China [Abstract] Objective To summarize the experience of surgical treatment of complete atrioventricular canal defect of our hospital in recent years. Methods From Jan-uary 2003 to December 2008, 44 patients underwent the surgical treatment of com-plete atrioventricular canal defect .There were 27 males and 17 females. Ages from 4 months to 12 years , 8 patients were less than one-year. Weights from 5 to 21kg, and the average of which is 8.7kg. Rastelli type：43 cases in A-type (of which 17 cases of transitional type), 1 case in B-type. Malformation includes 2 tetralogy of Fallot(F4),6 patent ductus arteriosus(PDA),2 right ventricular outflow tract stenosis,4 persistent left superior vena.Surgery was operated in hypothermic cardiopulmonar-y bypass in a shallow manner.Dealt with using glutaraldehyde autologous pericardi-um patch for suture and repair septal defect, of which using single-patch technique- in 6 cases and using two-patch technique in 21 cases.The VSD of 17 cases in tr-ansitional type were repaired under direct pressure valve,interrupted suture bicuspid and tricuspid valve split,repeating injection test until the closure of the mitral