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目的总结动脉调转手术冠状动脉分型及相应的手术方法和结果。方法回顾分析1999年10月至2005年10月102例行动脉调转手术病儿,男73例,女29例。年龄3 d～7岁;体重2.5～20.0kg。主动脉位于肺动脉右前方74例(72.5%),左前11例(10.8%),正前方10例(9.8%),并列关系7例(6.8%)。其中简单大动脉转位55例,复杂大动脉转位29例,Taussing-Bing 畸形18例。采用 Leiden 冠状动脉分型方法,1LCx2R 为冠状动脉正常分布,共69例,其他类型为冠状动脉异常分布,共33例,其中3例冠状动脉壁内走行。冠状动脉吻合主要采用带片开门技术或吊窗技术,病儿均应用 Lecompte 技术。结果死亡15例,手术死亡率14.7%。冠状动脉正常者死亡6例(8.7%,6/69例),冠状动脉异常分布者死亡9例(27.3%,9/33例)。简单大动脉转位死亡5例中3例发生冠状动脉事件,其中2例冠状动脉变异。复杂型大动脉转位死亡6例中4例发生冠状动脉事件,其中3例冠状动脉变异。Taussing-Bing 畸形死亡4例中3例发生冠状动脉事件,均存在冠状动脉变异。结论复杂冠状动脉类型增加手术风险,熟悉冠状动脉分型、提高外科技术和积累经验是降低风险的关键。
Objective To summarize the coronary artery classification of arterial transfer surgery and the corresponding surgical methods and results. Methods Retrospective analysis of 102 cases of arterial transfer surgery in October 1999 to October 2005 sick children, 73 males and 29 females. Age 3 d ~ 7 years old; body weight 2.5 ~ 20.0kg. The aorta was located in the right front of the pulmonary artery in 74 cases (72.5%), left front in 11 cases (10.8%), anterior in 10 cases (9.8%), and in 7 cases (6.8%). Among them, 55 cases were transplanted simple aorta, 29 cases transplanted in complex aorta and 18 cases were Taussing-Bing malformation. The Leiden coronary artery classification method, 1LCx2R for the normal distribution of coronary arteries, a total of 69 cases, the other type of abnormal distribution of coronary arteries, a total of 33 cases, including 3 cases of coronary artery wall. Coronary artery anastomosis with open the door or hanging window technology, sick children are using Lecompte technology. Results of death in 15 cases, surgical mortality was 14.7%. 6 cases (8.7%, 6/69 cases) died of normal coronary arteries and 9 cases (27.3%, 9/33 cases) died of abnormal distribution of coronary arteries. Coronary artery events occurred in 3 of 5 patients who died of transposition of the simple arteries, and 2 of them had variant coronary arteries. Coronary artery events occurred in 6 of the 6 patients who transplanted into the complex aorta, and 3 of them had variant coronary arteries. Taussing-Bing deformity death in 4 cases, 3 cases of coronary events, there are coronary artery variability. Conclusions Complex coronary arteries increase the risk of surgery, familiarization with coronary artery classification, improvement of surgical techniques and accumulation of experience are the key to reducing the risk.