先天性心脏病伴永存左上腔静脉的诊断及术中处理

摘要

Objective To summarize the experience of diagnosis and treatment of perisistent left superior vena cave(PLSVC),in order to improve the right realization about the left superior vena cava.Methods Among 3342 patients with congenital heart disease treated by open-heart operation,76 cases were associated with PLSVC with an incidence of 2.27%.Gathered the statistics on its incidence in different types of congenital heart disease,to provide the experience on preoperative diagnosis.According to the drainage position of PLSVC,take a temporary block or cannulation drainage to ensure that no blood in operation view,and after the correction to the heart of the system ligate PLSVC or drain it to right atrium to ensure the normal bloodstream dynamics.Results There were 5 hospital deaths,but had no connection with the management of PLSVC,Others had good surgical result.Conclusions ①PLSVC is common among congenital heart disease,and the more complex congenital heart disease,the higher incidence of the PLSVC.② The diagnosis of PLSVC is difficult.The preoperative should be strengthen and the probe is important.③Key of success of surgical approach of PLSVC is precise evaluation of different drainage position and different surgical approach.%目的 总结先天性心脏病伴永存左上腔静脉(PLSVC)的诊断与治疗经验,以提高对左上腔静脉的正确认识.方法 统计先天性心脏病手术3342例,发现PLSVC 76例,发生率2.27%.统计其在不同先天性心脏病类型中的发生率,给术前诊断提供经验.并根据PLSVC的不同引流部位,采取临时阻断或插管引流以保证手术视野无血,待心内畸形矫正后予以结扎或引流入右心系统以保证正常的血流动力学.结果 全组死亡5例,但与左上腔静脉的处理无关,其余均恢复良好.结论 ①PLSVC畸形在先天性心脏病中较为常见,且在较为复杂的先天性心脏病中发生率较高.②PLSVC易漏诊,应加强术前诊断,重视术中探查.③术中应根据PLSVC的不同引流部位而采用不同的处理方式.