三種手術矯治靜脈竇型房間隔缺損的臨床結果_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 陳仁偉 ^1,2 , 羅金文 ¹ , 陽廣賢 ¹ , 鄧喜成 ¹ , 黃鵬 ¹

1. ;
2. ;

Corresponding?author：

陳仁偉, Email: chenrenwei@sina.com

Keywords：

靜脈竇型房間隔缺損; 肺靜脈異位連接; Warden 手術

DOI：

10.7507/1007-4848.201712004

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目的總結靜脈竇型房間隔缺損（SVASD）合并部分性肺靜脈異位連接（PAPVC）外科治療的臨床結果。方法回顧性分析 2000 年 1 月至 2016 年 12 月湖南省兒童醫院 49 例 SVASD/PAPVC 患者的臨床資料，其中男 21 例、女 28 例，年齡 5 個月～14 歲，平均年齡（4.7±2.1）歲。肺靜脈異位連接位置位于右房者 9 例，位于右房與上腔靜脈連接部者 12 例，位于上腔靜脈者 28 例。根據手術方式分為三組，A 組 29 例采用單片心包補片修補，B 組 12 例采用雙片心包補片修補，C 組 8 例將上腔靜脈近心端引入左房、上腔靜脈遠心端與右心耳吻合（Warden 手術）進行矯治。結果手術效果滿意，心內無殘余分流，無手術死亡病例，無再手術者，無肺靜脈回流梗阻病例出現。隨訪 6 個月至 15 年，術后 7 例上腔靜脈流速增高，其中 A 組 4 例（13.8%），B 組 2 例（9.5%），C 組 1 例（12.5%）。術后 7 例竇房結功能異常，其中 A 組 3 例（10.3%，隨訪恢復竇性心律），B 組 4 例（19.0%，隨訪時 3 例恢復竇性心律，1 例為結性心律），C 組無竇房結功能異常病例出現。結論 SVASD 多伴有右側肺靜脈異位連接，矯正 SVASD 時應注意防止上腔靜脈和右側肺靜脈回流梗阻，并避免影響竇房結功能，選擇適當的手術方式可以減少并發癥的發生。Warden 手術能有效避免竇房結功能的影響，對于異位連接位置位于上腔靜脈高位者，Warden 法應作為首選。

Citation： 陳仁偉, 羅金文, 陽廣賢, 鄧喜成, 黃鵬. 三種手術矯治靜脈竇型房間隔缺損的臨床結果. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(11): 1012-1014. doi: 10.7507/1007-4848.201712004 Copy

1.	Park CS, Kwak JG, Lee C, et al. Partial anomalous pulmonary venous connection to the superior vena cava: the outcome after the Warden procedure. Eur J Cardiothorac Surg, 2012, 41(2): 261-265.
2.	Said SM, Burkhart HM, Dearani JA, et al. Outcome of caval division techniques for partial anomalous pulmonary venous connections to the superior vena cava. Ann Thorac Surg, 2011, 92(3): 980-985.
3.	Warden HE, Gustafson RA, Tarnay TJ, et al. An alternative method for repair of partial anomalous pulmonary venous connection to the superior vena cava. Ann Thorac Surg, 1984, 38(6): 601-605.
4.	朱宏斌, 張海波, 徐志偉, 等. 靜脈竇型房間隔缺損的外科治療. 中國胸心血管外科臨床雜志, 2006, 13(2): 86-88.
5.	李世國, 蔣世良, 呂濱, 等. 上腔靜脈竇型房間隔缺損的多層螺旋 CT 診斷. 中華放射學雜志, 2012, 48(6): 508-511.
6.	Ling Y, Gan C, Sandeep B, et al. Modified Warden procedure for partial anomalous pulmonary venous return to the superior vena cava. J Card Surg, 2016, 31(10): 631-634.
7.	Iyer AP, Somanrema K, Pathak S, et al. Comparative study of single- and double-patch techniques for sinus venosus atrial septal defect with partial anomalous pulmonary venous connection. J Thorac Cardiovasc Surg, 2007, 133(3): 656-659.
8.	Shahriari A, Rodefeld MD, Turrentine MW, et al. Caval division technique for sinus venosus atrial septal defect with partial anomalous pulmonary venous connection. Ann Thorac Surg, 2006, 81(1): 224-229.
9.	Hofmann M, Dave HH, Schmiady MO, et al. Warden procedure for correction of sinus venosus atrial septal defect and partial anomalous pulmonary venous connection. Multimed Man Cardiothorac Surg, 2016: 2016.
10.	Kim C, Cho YH, Lee M, et al. Surgery for partial anomalous pulmonary venous connections: modification of the warden procedure with a right atrial appendage flap. Korean J Thorac Cardiovasc Surg, 2014, 47(2): 94-99.
11.	Ramanan S, Sasikumar N, Manohar SR, et al. The warden procedure through a posterolateral thoracotomy approach. Tex Heart Inst J, 2014, 41(5): 499-501.
12.	Zubritskiy A, Arkhipov A, Khapaev T, et al. The Warden procedure can be successfully performed using minimally invasive cardiac surgery without aortic clamping. Interact Cardiovasc Thorac Surg, 2016, 22(2): 225-227.

1. Park CS, Kwak JG, Lee C, et al. Partial anomalous pulmonary venous connection to the superior vena cava: the outcome after the Warden procedure. Eur J Cardiothorac Surg, 2012, 41(2): 261-265.
2. Said SM, Burkhart HM, Dearani JA, et al. Outcome of caval division techniques for partial anomalous pulmonary venous connections to the superior vena cava. Ann Thorac Surg, 2011, 92(3): 980-985.
3. Warden HE, Gustafson RA, Tarnay TJ, et al. An alternative method for repair of partial anomalous pulmonary venous connection to the superior vena cava. Ann Thorac Surg, 1984, 38(6): 601-605.
4. 朱宏斌, 張海波, 徐志偉, 等. 靜脈竇型房間隔缺損的外科治療. 中國胸心血管外科臨床雜志, 2006, 13(2): 86-88.
5. 李世國, 蔣世良, 呂濱, 等. 上腔靜脈竇型房間隔缺損的多層螺旋 CT 診斷. 中華放射學雜志, 2012, 48(6): 508-511.
6. Ling Y, Gan C, Sandeep B, et al. Modified Warden procedure for partial anomalous pulmonary venous return to the superior vena cava. J Card Surg, 2016, 31(10): 631-634.
7. Iyer AP, Somanrema K, Pathak S, et al. Comparative study of single- and double-patch techniques for sinus venosus atrial septal defect with partial anomalous pulmonary venous connection. J Thorac Cardiovasc Surg, 2007, 133(3): 656-659.
8. Shahriari A, Rodefeld MD, Turrentine MW, et al. Caval division technique for sinus venosus atrial septal defect with partial anomalous pulmonary venous connection. Ann Thorac Surg, 2006, 81(1): 224-229.
9. Hofmann M, Dave HH, Schmiady MO, et al. Warden procedure for correction of sinus venosus atrial septal defect and partial anomalous pulmonary venous connection. Multimed Man Cardiothorac Surg, 2016: 2016.
10. Kim C, Cho YH, Lee M, et al. Surgery for partial anomalous pulmonary venous connections: modification of the warden procedure with a right atrial appendage flap. Korean J Thorac Cardiovasc Surg, 2014, 47(2): 94-99.
11. Ramanan S, Sasikumar N, Manohar SR, et al. The warden procedure through a posterolateral thoracotomy approach. Tex Heart Inst J, 2014, 41(5): 499-501.
12. Zubritskiy A, Arkhipov A, Khapaev T, et al. The Warden procedure can be successfully performed using minimally invasive cardiac surgery without aortic clamping. Interact Cardiovasc Thorac Surg, 2016, 22(2): 225-227.

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三種手術矯治靜脈竇型房間隔缺損的臨床結果

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