单中心116例一期全腔静脉肺动脉连接术的临床研究  

Medical Results of One-stage Fontan Procedure in 116 Patients at A Single Institute

作　　者：刘巍 刘锦纷[1] 徐志伟[1] 张海波[1] 郑景浩[1] 祝忠群[1] 严勤[1] 王顺民 仇黎生 朱宏斌 鲁亚南 陈会文 

机构地区：[1]上海交通大学医学院附属上海儿童医学中心胸外科,上海200127

出　　处：《中国胸心血管外科临床杂志》2016年第2期142-146,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：上海市卫生局科研课题项目(20134026);上海交通大学"医工(理)交叉研究"项目(YG2012MS17)~~

摘　　要：目的回顾性分析功能性单心室患者行一期全腔静脉肺动脉连接术的临床疗效。方法回顾性分析上海儿童医学中心心脏中心2008年1月至2013年9月行一期Fontan术116例患者的临床资料，其中男77例、女39例。手术年龄6．27（3．15±17．47）岁，体重17．5（10．0—80．0）kg，术中采用心外管道法55例，改良自体肺动脉下拉法13例，心房内（或心房内／外）管道法17例和心房侧隧道法31例。结果术后早期死亡6例（5．1％）。体外循环时间124（61-256）min，主动脉阻断时间60（19—152）min。术后住重症监护室时间4（1—17）d，呼吸机辅助通气7．3（1．0～181．0）h；出院前动脉血氧饱和度90．00％±4．68％，胸腔引流管留置时间10（4～45）d。多元logistic分析模型提示内脏不定位或内脏反位是术后肾功能不全（OR=5．351，95％CI1．506～19．014）的唯一危险因素；术中主动脉阻断（OR=26．184，95％CI1．712～400．451）、术前窦性心律异常（OR=6．777，95％CI1．495．30．721）和主动脉阻断时间〉60min（OR=1．036，95％CI1．002～1．076）是术后胸腔引流的主要危险因素。术后随访病例110例，其中2例中晚期死亡，随访时间17（8～47）个月，1例发生管道血栓形成，无再次手术病例。结论一期全腔静脉肺动脉连接术治疗功能性单心室患者的临床疗效满意，现有的分期策略对年龄较大的患者可适当放宽。Objective To analyze the outcomes of patients with one-stage Fontan procedure and short-term prognosis at a single institute. Method We retrospectively analyzed clinical records of 116 patients with one-stage Fontan procedure in our hospital from January 2008 through September 2013. There were 77 males and 39 females （36%）, with median age 6.27 years （ranged 3.15 to 17.47 years） at the time of surgery and the median weight at 17.5 kg （ranged 10.0 to 80.0 kg）. There were 55 patients with standard extracardiac conduit, 13 patients with direct extracardiac connection, 17 patients with intra-atrial or intra/extracardiac conduit, and 31 patients with lateral tunnel. Results Median cardiopulmonary bypass time was 124 （61-256） minutes. Median cross-clamp time was 60 （19-152） minutes. There were six early deaths （5.1%）. The overall median time of the cardiac intensive care unit stay was 4 （1-17） days, with a median ventilator support of 7.3 （1.0-181.0） hours. The mean room air saturation was 90.00%_＋4.68% before discharge. Median length of chest tube drainage was 10 （4-45） days. Multiple logistic analysis confirmed that heterotaxy syndrome was the only independent predictor for postoperative renal insufficiency. Operations with aortic cross-clamping （OR=26.184, 95% CI 1.712-400.451）, preoperative sinus mode dysfunction （OR=6.777, 95% CI 1.495-30.721） and cross- clamp time over 60 minutes （OR=1.036, 95% CI 1.002-1.076） were predictors for prolonged chest tube drainage. A total of 110 patients were followed up for 17 （8-47） months with 2 deaths and 1 with thrombosis. No reoperation occurred. Conclusion The one-stage Fontan procedure can be performed with satisfactory outcomes. Staged strategies for operations may be appropriately loosen for selected elder children.

关 键 词：全腔静脉肺动脉连接术 FONTAN手术 单期策略 功能性单心室 

分 类 号：R654.2[医药卫生—外科学]