Talwar Sachin, Das Anupam, Choudhary Shiv Kumar, Airan Balram
Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India.
World J Pediatr Congenit Heart Surg. 2016 Mar;7(2):146-51. doi: 10.1177/2150135115627651.
Persistent pleural effusions are a major source of morbidity after univentricular repair. These are often refractory to conventional conservative therapy. We adopted a strategy of diaphragmatic fenestration (DF) in such patients and report the results.
Between January 2002 and 2014, we performed DF in 12 patients using an original technique that was first described by us. The medical records of all these patients were studied. Preoperative characteristics, amount and duration of effusions, and time to removal of chest tubes following DF were studied.
Mean age was 101 ± 57.9 months (range: 38-180 months), and mean body weight was 18.8 ± 5.8 kg (range: 11-28 kg). Five had a bidirectional Glenn, four had lateral tunnel Fontan, and three had an extracardiac Fontan as initial procedure. The average pleural drainage prior to DF was 352.5 ± 152 mL/24 h (18.75 mL/kg/24 h) for a median period of 33 days (bidirectional Glenn 216 ± 85 mL/24 h [16.5 mL/kg/24 h] for 30 days and total cavopulmonary connection 450 ± 104 mL/24 h [22.5 mL/kg/24 h] for 36 days). All patients underwent DF. Additionally, five patients underwent thoracic duct ligation on the left side. Postoperative chest drainage after DF was 25 mL/d for a median of 4 days, and the chest tubes could be removed in a median of 5.5 days (mean 7 days). There were no complications related to DF.
In patients with persistent pleural effusions following univentricular palliation, DF is an attractive option when conventional therapies have failed. This original technique of DF is simple, reproducible, cost-effective, and free of any known complications.
持续性胸腔积液是单心室修复术后发病的主要原因。这些积液通常对传统保守治疗无效。我们在此类患者中采用了膈开窗术（DF）并报告结果。
2002年1月至2014年期间，我们采用首次由我们描述的原始技术对12例患者进行了DF。研究了所有这些患者的病历。研究了术前特征、积液量和持续时间以及DF后拔除胸管的时间。
平均年龄为101±57.9个月（范围：38 - 180个月），平均体重为18.8±5.8千克（范围：11 - 28千克）。5例患者最初接受了双向格林分流术，4例接受了侧隧道式Fontan手术，3例接受了心外Fontan手术。DF前平均胸腔引流量为352.5±152毫升/24小时（18.75毫升/千克/24小时），中位时间为33天（双向格林分流术为216±85毫升/24小时[16.5毫升/千克/24小时]，持续30天；全腔肺连接术为450±104毫升/24小时[22.5毫升/千克/24小时]，持续36天）。所有患者均接受了DF。此外，5例患者接受了左侧胸导管结扎术。DF后术后胸腔引流量为25毫升/天，中位时间为4天，胸管中位拔除时间为5.5天（平均7天）。没有与DF相关的并发症。
对于单心室姑息治疗后持续性胸腔积液的患者，当传统治疗失败时，DF是一个有吸引力的选择。这种DF的原始技术简单、可重复、具有成本效益且无任何已知并发症。
