多次手术的复杂先天性心脏病外科治疗预后的单中心分析  

Outcomes of complicated congenital heart diseases following multiple re-sternotomy operations:A single-center experience

作　　者：彭永宣[1] 杜欣为[1] 王顺民[1] 郑景浩[1] 张海波[1] 张浩[1] PENG Yongxuan;DU Xinwei;WANG Shunmin;ZHENG Jinghao;ZHANG Haibo;ZHANG Hao(Department of Cardiothoracic Surgery,Shanghai Children's Medical Center,National Children's Medical Center,Shanghai Institution of Pediatric Congenital Heart Disease,Medical School of Shanghai Jiao Tong University,Shanghai,200127,P.R.China)

机构地区：[1]国家儿童医学中心,上海交通大学医学院附属上海儿童医学中心胸心外科,上海市小儿先天性心脏病研究所,上海200127

出　　处：《中国胸心血管外科临床杂志》2020年第6期635-639,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：上海市医学领军人才计划(2019);国家杰出青年科学基金(81525002)。

摘　　要：目的研究行多次(3次或以上)开胸手术的复杂先天性心脏病(CCHD)外科治疗患者的预后。方法回顾性分析2015~2019年在单中心行三期及以上开胸心脏手术的146例患者的临床资料,其中男95例、女51例,末次手术时年龄4.3(3.1~6.8)岁,体重15.3(13.4~19.0)kg。结果最多的3个病种分别为肺动脉闭锁(51例,34.9%)、右心室双出口(36例,24.7%)、功能性单心室(36例,24.7%)。146例患者共行开胸手术457次,其中行3次手术129例(88.3%),行3次以上手术17例(11.7%)。诊治过程中完成双心室根治52例(35.6%),完成Fontan手术63例(43.1%),仍处于姑息手术阶段31例(21.2%)。开胸过程中发生意外10例(6.8%),其中需股动静脉转流7例(4.8%)。总死亡11例(7.5%),其中住院期间死亡10例(6.8%)。随访20.0(5.8~40.1)个月,随访期间死亡1例。手术次数是多次CCHD手术死亡的独立危险因素(R=5.8)。结论单心室的Fontan系列手术、双心室矫治术后反复肺动脉或右室外管道狭窄是CCHD多次手术的主要原因。多次手术是CCHD治疗面临的一大挑战,应尽量避免多次开胸手术。Objective To analyze the outcomes of complicated congenital heart diseases(CCHD)patients accepting multiple(>2)re-sternotomy operations.Methods We retrospectively analyzed the clinical data of 146 patients undergoing multiple cardiac re-sternotomy operations between 2015 and 2019 in our center.There were 95 males and 51 females with an age of 4.3(3.1-6.8)years and a weight of 15.3(13.4-19.0)kg at last operation.Results The top three cardiac malformations were pulmonary atresia(n=51,34.9%),double outflow of right ventricle(n=36,24.7%)and functional single ventricle(n=36,24.7%).A total of 457 sternotomy procedures were performed,with 129(88.3%)patients undergoing three times of operations and 17(11.7%)patients undergoing more than three times.Fifty-two(35.6%)patients received bi-ventricular repair,63(43.1%)patients received Fontan-type procedures,and 31(21.2%)patients underwent palliative procedures.Ten(6.8%)patients experienced major accidents during sternotomy,including 7(4.8%)patients of urgent femoral artery and venous bypass.Eleven(7.5%)patients died with 10(6.8%)deaths before discharge.The follow-up time was 20.0(5.8-40.1)months,and 1 patient died during the follow-up.The number of operations was an independent risk factor for the death after operation.Conclusion Series operations of Fontan in functional single ventricle,repeated stenosis of pulmonary artery or conduit of right ventricular outflow tract post bi-ventricular repair are the major causes for the reoperation.Multiple operations are a huge challenge for CCHD treatment,which should be avoided.

关 键 词：先天性心脏病 再次手术 功能性单心室 肺动脉闭锁 右心室双出口 治疗 

分 类 号：R654.2[医药卫生—外科学]