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目的总结1998年4月至2005年12月行双向 Glenn 手术治疗68例儿童功能性单心室的经验。方法本组男47例,女21例;年龄5个月～14岁(中位年龄3.7岁);体重6.7～30.0 kg(中位体重12.5 kg)。右侧双向 Glenn 手术39例,左侧双向 Glenn 手术13例,双侧者16例。同期行肺动脉环束3例、肺动脉结扎1例、主动脉-肺动脉分流管道切断缝合术1例、动脉导管结扎6例、大侧支循环切断4例、全肺静脉异位引流矫治1例、部分肺静脉异位引流矫治2例、房室瓣整形4例。结果 68例患者死亡3例,病死率4.4%。术后上腔静脉压力(15.9±2.4)mm Hg(1 mm Hg=0.133kPa),较术前的(8.3±1.8)mm Hg 显著上升(P<0.01)。术后安静时经皮血氧饱和度(89.3±4.2)%,较术前的(78.4±6.0)%显著上升(P<0.01)。结论双向 Glenn 手术治疗功能性单心室效果满意;双向 Glenn 手术宜保留肺动脉的搏动性血流。
Objective To summarize the experience of bi-directional Glenn surgery from April 1998 to December 2005 in 68 children with functional single ventricle. Methods The group of 47 males and 21 females; aged 5 months to 14 years (median age 3.7 years); weight 6.7 to 30.0 kg (median body weight 12.5 kg). Right Glenn operation in 39 cases, left bilateral Glenn operation in 13 cases, bilateral in 16 cases. In the same period, 3 cases of pulmonary artery ring bundle, 1 pulmonary artery ligation, aortic - pulmonary artery shunt suture in 1 case, 6 cases of patent ductus arteriosus, large collateral circulation in 4 cases, total anomalous drainage in 1 case, part of the pulmonary veins Ectopic drainage treatment in 2 cases, atrioventricular valve flap in 4 cases. Results 68 patients died in 3 cases, the mortality rate was 4.4%. Postoperative superior vena cava pressure (15.9 ± 2.4) mm Hg (1 mm Hg = 0.133 kPa) was significantly higher than that preoperatively (8.3 ± 1.8) mm Hg (P <0.01). The postoperative quietness of percutaneous oxygen saturation (89.3 ± 4.2)%, compared with preoperative (78.4 ± 6.0)% increased significantly (P <0.01). Conclusions Two-way Glenn operation is satisfactory for functional single ventricle. Bilateral Glenn operation should preserve the pulsatile flow of pulmonary artery.