非体外循环下双向格林术19例-东南大学学报医学版

非体外循环下双向格林术19例

单位：1.南通瑞慈医院心胸外科,江苏,南通,226010； 2.东南大学附属中大医院心胸外科,江苏,南京,210009

关键词：肺楔压腔静脉上/外科学心包/移植心脏缺损先天性/外科学心脏外科手术/方法

分类号：R331.37, R726.541, R726.542, R726.543

出版年·卷·期（页码）：2004·23·第四期（259-261）

摘要：

目的:总结常温非体外循环下双向格林分流术(Glenn术)治疗复杂先天性心脏病的体会.方法:1999年7月至2003年8月,对复杂性先天性心脏病患者19例行双向Glenn术.其中17例建立上腔静脉-右心房旁路行单侧双向Glenn术,2例利用双上腔静脉互为旁路行双侧双向Glenn术.结果:全组无住院死亡,术后并发乳糜胸1例,远期无肺动、静脉瘘发生,动脉血氧饱和度从术前(78±11)%上升至术后 (92±6)%,活动耐力显著增加.结论:对于难以解剖根治或一期生理矫治的肺血少型复杂先天性心脏病,非体外循环下行Glenn术是一种安全、可靠的手术方法.在吻合口前壁用自体心包片加宽,可获得良好的吻合口通畅效果.

Objective To summarize the experiences of off-pump bi-directional Glenn shunt (Glenn shunt) in the treatment of complex congenital heart diseases.Methods Between July 1999 and August 2003,19 patients with complex congenital disease underwent off-pump bi-directional Glenn shunt: unilateral bi-directional cavoatrial Glenn shunt in 17 cases and bilateral bi-directional Glenn shunt in 2 cases. Results No hospitalized mortality in our group. Chylothorax found in 1 patient. No pulmonary arteriovenous fistula occurred. The average SaO 2 was elevated from (78±11)% before surgery to (92±6)% after. The stamina were markedly improved.Conclusion The off-pump bi-directional Glenn shunt is a safe and reliable method in the treatment of such complex congenital heart diseases as hard to be anatomically cured or stage-I physiologically rectified. The widening of the anterior wall of the anastomosis with auto-pericardium can ensure a good patency of the anastomosis.

参考文献：

[1] GLENN W W L. Circulatory bypass of the right side of the heart IV shunt between superior vena cava and distal right pulmonary artery-report of clinical application, 1958(3)
[2] ABRAMS L D. Side to side cavopulmonary anastomosis for the palliation of "primitive ventricle", 1997(2)
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