跨瓣环补片法洛四联症根治术后远期疗效  

Long-term results of right ventricular outflow tract patching in total repair of tetralogy of Fallot

作　　者：季巍[1] 杨能善[1] 李玲[1] 吴邦骏[1] 顾虹[1] 金梅[1] 罗毅[1] 

机构地区：[1]首都医科大学附属北京安贞医院小儿心脏科,北京100029

出　　处：《中国医药》2012年第4期452-455,共4页China Medicine

摘　　要：目的研究跨肺动脉瓣环补片法洛四联症（TOF）一期根治术患者术后远期疗效。方法回顾性分析1985年3月至1989年12月单中心TOF根治术采用跨瓣环补片（rrAP）并痊愈出院的患儿89例，79例资料完整，随访率88．8％。分析此79例患儿的生存率、免除再干预率和术后远期的心脏结构异常、功能异常及再干预情况；对可能与远期不良事件的发生相关的围术期因素进行Cox危险因素分析。结果79例跨肺动脉瓣环补片TOF一期根治术患儿中随访死亡15例（19．0％），心力衰竭和猝死为首要死因。远期再干预5例（6．3％），主要病因是心律失常、右心室流出道残留狭窄和心室水平残余分流。患儿5、10、20、25年的生存率和免除再干预率分别为（88．5±3．6）％、（83．1±4．3）％、（80．2±4．6）％、（80．2±4．6）％和（98．6±1．3）％、（94．0±2．9）％、（92．3±3．3）％、（92．3±3．3）％。手术年龄≤1岁（RR=6．7，P=0．001）是影响术后远期随访不良事件发生的独立危险因素；TAP±单瓣对患儿远期生存率、免除再干预率和免除远期不良事件发生率没有影响。结论TOF患儿TAP一期根治术后远期会出现患儿心脏结构及功能异常；手术年龄≤1岁的患儿，远期随访不良事件发生率可能更高。Objective To evaluate the long-term outcomes of right ventricular outflow tract patching in total repair of tetralogy of Fallot. Methods Between Mar. 1985 and Nov. 1989, a total of 89 patients underwent total repair for tetralogy of Fallot. Altogether 79 patients completed the revisit, revisit （88.8%）. Kaplan-Meier method with the log-rank test and Cox proportional hazards regression analysis were used to analysis the lone-term survival, freedom from rentervention and freedom from long-term adverse events. Results There were 15 late deaths （ 19. 0% ） and the main causes of death were heart failure and sudden death. Re-intervention was required in 5 patients （6. 3% ） and the most common causes of re-intervention were arrhythmia, RVOT re-obstruction and residual ventricular septal defects. The overall survival rate was （ 88.5 ± 3.6 ） % , （ 83.1±4. 3 ） %, （ 80. 2 ± 4. 6 ） %, （80.2±4.6）% at 5, 10, 20 and 25 years; freedom from re-intervention rate was （98.6± 1.3）%, （94.0 ±2.9）%, （92.3±3.3）% and （92.3±3.3）% at 5, 10, 20 and 25 years. Age≤1 year（RR=6.7,P=0.001） was the risk factor for long-term adverse events. The use of a monocusp in patients who underwent trans-annular repair showed no benefit for lone-term survival, avoidance of re-intervention and long-term adverse events. Conclusion The long-term outcome of right ventricular outflow tract patching in total repair for tetralogy of Fallot is not satisfactory; age is a risk factor of long-term adverse events.

关 键 词：法洛四联症 跨瓣环补片 远期疗效 

分 类 号：R654.2[医药卫生—外科学]