完全性房室通道的外科治疗

《完全性房室通道的外科治疗》由会员上传分享，免费在线阅读，更多相关内容在行业资料-天天文库。

1、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—21Kg，平均8.7Kg。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

2、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Ⅲ0AVB5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

3、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SurgicalTreatmentofCompleteAtrioventricularCanalDefectDENGSheng,LIUYongBo,BaiTao.DepartmentofCardiovascularSurgery,Guangxi2stpeople,shospital,Guilin541002,China[Abstract]ObjectiveTosummarizetheexperi

4、enceofsurgicaltreatmentofcompleteatrioventricularcanaldefectofourhospitalinrecentyears.MethodsFromJan-uary2003toDecember2008,44patientsunderwentthesurgicaltreatmentofcom-pleteatrioventricularcanaldefect.Therewere27malesand17females.Agesfrom4monthsto12years,8p

5、atientswerelessthanone-year.Weightsfrom5to21kg,andtheaverageofwhichis8.7kg.Rastellitype：43casesinA-type(ofwhich17casesoftransitionaltype),1caseinB-type.Malformationincludes2tetralogyofFallot(F4),6patentductusarteriosus(PDA),2rightventricularoutflowtractstenos

6、is,4persistentleftsuperiorvena.Surgerywasoperatedinhypothermiccardiopulmonar-ybypassinashallowmanner.Dealtwithusingglutaraldehydeautologouspericardi-umpatchforsutureandrepairseptaldefect,ofwhichusingsingle-patchtechnique-in6casesandusingtwo-patchtechniquein21

7、cases.TheVSDof17casesintr-ansitionaltypewererepairedunderdirectpressurevalve,interruptedsuturebicuspidandtricuspidvalvesplit,repeatinginjectiontestuntiltheclosureofthemitralvalvewassatisfing.Coronarysinuswasrepairedbyshallowsuture,andcoronarysinusopenedinther

8、ightatrium.Results1casediedduringoperation,2casesdiedinpostoperation,5caseswereoccurredwithatrioventricularblockIIIdegreesintheearlypostoperation,4casesrestoratedthesinusrhythmwithtreatme