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目的总结新生儿期心上型完全性肺静脉异位引流(TAPVD)的手术治疗经验,推广心上法在TAPVD手术治疗中的应用。方法回顾性分析2008年8月至2013年8月上海儿童医学中心收治新生儿期心上型梗阻型TAPVD患儿7例的临床资料,其中男5例、女2例,年龄8~28(18.3±7.7)d,体重3.1~4.5(3.57±0.47)kg。全部患儿在全身麻醉低温体外循环下行心上法矫治术。结果 7例患儿术后早期(1个月内)无死亡。随访3个月至4年,吻合口均保持通畅,无明显肺静脉回流梗阻,中期随访无心律失常及死亡发生。结论心上法矫治新生儿期心上型TAPVD可获得较大吻合口,减少心房内操作,有效降低术后死亡率、心律失常及吻合口再狭窄率。
Objective To summarize the experience of surgical treatment of neonatal cardiovertic pulmonary venous allograft (TAPVD) and to promote the application of Xinanshang method in the surgical treatment of TAPVD. Methods The clinical data of 7 cases of neonatal cardiogenic obstructive TAPVD admitted to Shanghai Children’s Medical Center from August 2008 to August 2013 were retrospectively analyzed. There were 5 males and 2 females, aged from 8 to 28 (18.3 ± 7.7) d, body weight 3.1 ~ 4.5 (3.57 ± 0.47) kg. All children undergoing general anesthesia hypothermia cardiopulmonary bypass surgery. Results 7 patients had no death in the early postoperative period (within 1 month). All the patients were followed up for 3 months to 4 years. The anastomotic sites remained unobstructed, obstructive pulmonary venous return was not observed, and no arrhythmia and death occurred during the follow-up. Conclusions The superior cardiac approach to the correction of neonatal cardiac TAPVD can get a larger anastomosis, reduce the atrial operation, effectively reducing the postoperative mortality, arrhythmia and anastomosis restenosis rate.