Uno Yoshimasa, Masuoka Ayumu, Hotoda Kentaro, Katogi Toshiyuki, Suzuki Takaaki
Department of Pediatric Cardiovascular Surgery, International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan.
Gen Thorac Cardiovasc Surg. 2016 Oct;64(10):592-6. doi: 10.1007/s11748-016-0685-5. Epub 2016 Jul 8.
In recent years, the median sternotomy approach with cardiopulmonary bypass has been increasingly chosen when systemic-pulmonary shunt surgery is performed as initial palliation for congenital heart diseases with decreased pulmonary blood flow to secure a stable surgical field and to maintain a stable circulation and oxygen supply. Since 2007, this strategy has been applied in our institute. This time, we examine the advantage and disadvantage of this procedure by evaluating the intraoperative and postoperative courses.
The study investigated 60 cases that underwent systemic-pulmonary shunt surgery under cardiopulmonary bypass at our facility after August 2007. Original diagnosis, age and body weight at surgery, shunt procedure, concomitant procedure, and surgical times were evaluated. The postoperative course of each case and the results of subsequent surgeries were also examined.
No death or severe complication occurred during surgery or in the perioperative period. The age at surgery was 4 days-12 years (median 5.1 months), and the body weight was 2.3-28.1 (median 4.7) kg. Surgical procedures were as follows: right modified Blalock-Taussig shunt (mBTS): 35, left mBTS: 11, and central shunt: 14. In addition, the following simultaneous surgeries were conducted: pulmonary artery plasty: 11, unifocalization: 5, main pulmonary artery ligation: 2, interatrial communication enlargement: 4, and total anomalous pulmonary venous drainage repair: 2.
The outcomes at our facility have validated the safety of systemic-pulmonary shunt surgeries under cardiopulmonary bypass, and even the disadvantages of concern were believed to be within acceptable limits. Further innovation and examination are important in pursuit of even less invasive surgeries.
近年来，对于肺血流量减少的先天性心脏病，在进行体肺分流手术作为初始姑息治疗时，越来越多地选择体外循环下正中胸骨切开术，以确保手术视野稳定，并维持稳定的循环和氧气供应。自2007年以来，该策略已在我院应用。此次，我们通过评估术中及术后过程来研究该手术的优缺点。
本研究调查了2007年8月后在我院接受体外循环下体肺分流手术的60例患者。评估了初始诊断、手术时的年龄和体重、分流手术方式、同期手术以及手术时间。还检查了每个病例的术后过程及后续手术结果。
手术期间及围手术期均未发生死亡或严重并发症。手术年龄为4天至12岁（中位年龄5.1个月），体重为2.3至28.1（中位体重4.7）千克。手术方式如下：右改良布莱洛克-陶西格分流术（mBTS）：35例，左mBTS：11例，中心分流术：14例。此外，还进行了以下同期手术：肺动脉成形术：11例，单灶化手术：5例，主肺动脉结扎术：2例，房间隔交通扩大术：4例，完全性肺静脉异位引流修复术：2例。
我院的结果证实了体外循环下体肺分流手术的安全性，甚至相关的缺点也被认为在可接受范围内。在追求创伤更小的手术方面，进一步的创新和研究很重要。
