目的:总结我科行先天性心脏病合并其他畸形联合同期手术治疗的临床效果,探讨同期联合手术的可行性、安全性及优势,以期在临床推广联合手术方法.方法:回顾总结2015年6月至2015年12月间,在我科行先天性心脏病合并其他畸形联合同期手术的患者情况.总结联合手术时间、手术方法、术后监护室滞留时间、气管插管时间、合并手术的部位出血情况及围术期死亡率.结果:在此期间共有8例患儿行先天性心脏病合并其他畸形联合同期手术,其中男性4例,女性4性,中位年龄21(10,98)个月,平均体质量10.5(6.6,11.9)kg.先天性心脏病分别为房间隔缺损(ASD)5例,右心室双出口1例,右心室双出口合并ASD1例,动脉导管未闭合并ASD1例.合并畸形为双侧腹股沟斜疝2例,左侧腹股沟斜疝合并右侧鞘膜积液1例,右手赘生指1例,颈部肿物1例,隐睾1例,双眼霰粒肿1例,巨结肠合并气管狭窄1例.手术方式:1例ASD合并巨结肠的患儿在全身麻醉气管插管下先行ASD修补术后再行巨结肠根治加活检术,其他7例患儿均在全身麻醉气管插管下先行其他合并畸形根治术,之后在体外循环下行先天性心脏病矫治术,术后返回心脏外科术后监护室.联合手术时间170(163,233) min,先天性心脏病手术时间133(113,163) min,合并其他畸形矫治手术时间为45(31,75) min.8例患儿术后监护室滞留时间为(5.8±9.4)d.1例右心室双出口合并左斜疝、右鞘膜积液的患儿监护室滞留时间28d,原因为心功能减低及感染使其延长,与合并畸形无关.1例ASD合并巨结肠及气管狭窄患儿监护室滞留时间10d,原因为感染使其延长,与心脏手术无关.其余6例患儿术后监护室滞留时间为2(1,2)d.8例患儿术后气管插管时间为13(5,150)h.其中1例ASD合并双眼霰粒肿的患儿,因考虑到眼科手术后24h才能去除敷料,为避免患儿清醒后无法视物造成的恐惧感,我们将气管插管时间延长到术后22h去除眼科敷料.1例右心室双出口合并左斜疝、右鞘膜积液的患儿气管插管时间192h,原因为心功能减低及感染使其延长,与合并畸形无关.1例ASD合并巨结肠及气管狭窄患儿的患儿气管插管时间209h,原因为感染使其延长,与心脏手术无关.其余5例患儿术后气管插管时间为7(4,13)h.所有合并畸形的手术部位未出现因体外循环肝素化而发生的渗血情况.结论:对于合并其他畸形的先天性心脏病患儿可以在行先天性心脏病手术矫治同时行其他畸形矫治手术.其术后监护室滞留时间、气管插管时间大部分可根据患儿心脏手术后情况调整,无需考虑合并畸形对监护室滞留时间、气管插管的影响.患儿只需要经历一次麻醉、气管插管就可以同时解决不同系统解剖畸形,较以往需要分开手术而言,未出现任何手术并发症且具有减少创伤、降低费用、减少入院次数的优点,值得在临床推广.%Objective:To summarize the effect of combined operations for congenital heart disease and other malformation,to explore the feasibility,safety and advantages of combined operation,in order to promote the combined operationmethod In clinical situation.Methods:retrospective summary on June 6,2015-December 2015 in our department who underwent combined operations of congenital heart disease and other malformation.Summarizes the operation time,surgicalmethod and postoperative care condition including endotracheal intubation time and the bleeding volume on part of combined surgery.Results:during the period,7 cases of congenital heart disease with other malformation underwent the combined operation,male 4 cases,female 4 cases.Age 21 (10,98) mouth,body mass 10.5 (66,11.9) kg.5 cases of atrial septal defects(ASD),1 case of double outlet of right ventricle,1 case of double outlet of right ventricle with ASD,1 case of Patent Ductus Arteriosus(PDA) with ASD.Combined malformation of bilateral inguinal hernia in 2 cases,left inguinal hernia with the right hydrocele in 1 case,right hand polydactylism in 1 case,neck neoplasm in 1 case,cryptorchidism in 1 case,chalazion in 1 case,megacolon in1 cases.The operation was carried out under a general anaesthesia with intubation.All the combined malformation were correct before the the operation of congenital heart disease using cardiac pulmonary bypass(CPB).After the operation the patients were send to cardiac critical intensive care unit(CICU).The total operation time was 170 (163,233) minutes,congenital heart disease surgery took 133 (113,163) minutes,combined operation time was 45(31,75) minutes.All of the patients stay in CICU for 12 (1,8) d.Among them,there was 1 case of double outlet of right ventricle with left oblique hernia and right hydrocele who had longer staying time of 28 days because of low cardiac output and infection.1 case of ASD with Congenital aganglionic megacolon and tracheostenosis who had longer staying time of 10days because of infection.For the other 6 patients the staying time was 2 (1,2) d.The ventilation time was 13 (5,150) h.There was 1 case of ASD with chalazion who had delayed intubation time for 22 hours because we want to avoid the fear of darkness with dressing covered her eyes after operation,1 case of double outlet of right ventricle with left oblique hernia and right hydrocele who had longer intubation time of 192 h because of low cardiac output and infection.1 case of ASD with Congenital aganglionic megacolon and tracheostenosis who had longer intubation time of 209 h because of infection.For the other 5 patients the ventilation time was 7 (4,13)h.There was no oozing of blood in incision because of heparinization.Conclusion:Patients who had congenital heart disease with other malformations can be corrected by operation at one time.The staying time and intubation time in CICU were decided by cardiac surgery without consideration of combined malformation for most of patients.Patients got all the malformation correct by one time endotracheal intubation and anesthesia.There was no more complications and less trauma,lower cost,reduced times of hospitalization.It is worth spreading in clinical application.
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