di Carlo D, Williams W G, Freedom R M, Trusler G A, Rowe R D
J Thorac Cardiovasc Surg. 1982 Mar;83(3):437-42.
The value of the cava-pulmonary anastomosis (Glenn procedure) was assessed by reviewing the entire experience with this procedure in 83 children at The Hospital for Sick Children, Toronto, from 1961 to 1980. The over-all operative mortality rate was 9.6%, but only 2% in the second half of the series. The average follow-up is 9.4 years per patient. The late mortality rate has been 20%. By actuarial analysis, 84% of survivors were alive 9 years after operation; 54% had adequate palliation and 46% had required further operation. Long-term palliation was significantly better when the anastomosis was performed after 5 years of age. A previous arterial pulmonary artery shunt had no effect on either patient or shunt survival. Patients with tricuspid atresia had a better long-term survival rate than, but similar shunt survival to, those children with transposition, single ventricle, or miscellaneous cardiac anomalies. Angiography in 36 survivors showed patent shunts in 35 and no arteriovenous fistulas. Clinical status was not related to superior vena caval pressure or angiographic findings, indicating that Glenn shunt failure is a functional problem. The procedure is most useful for patients over 5 years of age who have complex heart disease not amenable to total repair. It is also on appropriate initial procedure in young patients over 18 months of age for whom direct atrium--pulmonary artery anastomosis is proposed as the future definitive treatment.
通过回顾1961年至1980年多伦多病童医院对83例儿童进行腔肺吻合术（格伦手术）的全部经验，对该手术的价值进行了评估。总体手术死亡率为9.6%，但在该系列的后半期仅为2%。每位患者的平均随访时间为9.4年。晚期死亡率为20%。通过精算分析，84%的幸存者在术后9年仍存活；54%的患者得到了充分的姑息治疗，46%的患者需要进一步手术。5岁以后进行吻合术时，长期姑息治疗效果明显更好。先前的动脉肺动脉分流术对患者或分流术的存活均无影响。三尖瓣闭锁患者的长期存活率高于那些患有大动脉转位、单心室或其他心脏畸形的儿童，但分流术存活率相似。对36例幸存者进行的血管造影显示，35例分流术通畅，无动静脉瘘。临床状况与上腔静脉压力或血管造影结果无关，这表明格伦分流术失败是一个功能性问题。该手术对5岁以上患有无法进行完全修复的复杂心脏病的患者最为有用。对于18个月以上、拟将直接心房-肺动脉吻合术作为未来确定性治疗方法的年轻患者，它也是一种合适的初始手术。
