基于保留肺动脉瓣的法洛四联症矫治手术时机  

Clinical study on the timing of primary repair for tetralogy of Fallot based on pulmonary valve-sparing

作　　者：提运幸[1] 王元祥[1] 刘怀普[1] 王鹏程 黄骏荣 丁以群[1] Ti Yunxing;Wang Yuanxiang;Liu Huaipu;Wang Pengcheng;Huang Junrong;Ding Yiqun(Department of Cardiovascular Surgery,Shenzhen Children,Hospital,Shenzhen 518038,China)

机构地区：[1]深圳市儿童医院心血管外科,518038

出　　处：《中华胸心血管外科杂志》2020年第8期449-453,共5页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的从保留肺动脉瓣的角度探讨法洛四联症根治术的手术时机.方法回顾性分析深圳市儿童医院2015年6月至2019年5月间行法洛四联症根治术的患儿围术期资料,通过应用受试者操作特征曲线(ROC曲线)寻找保留肺动脉瓣的年龄临界值;按照此年龄的临界值将患儿分为两组,比较两组患儿术后机械辅助通气时间、住院天数、ICU滞留天数、急诊手术率、住院死亡比例、出院31天再入院率、肺动脉瓣保留率和快通道率等指标.结果按照纳入标准共纳入法洛四联症患儿105例,其中男67例,女38例,体质量4.2~21.5 kg,中位数7.9 kg,年龄1.3~99.1个月,中位月龄8.8个月.应用ROC曲线确定保留肺动脉瓣的年龄临界值为5.5~5.6个月(敏感度0.90,特异度0.58,95%CI:0.588~0.792).以年龄6个月为界值,将法洛四联症患儿分组后比较.≥6个月组患儿与<6月组患儿术后机械辅助通气时间、ICU滞留天数、急诊手术率、住院死亡比例、出院31天再入院率和快通道率差异均无统计学意义(P>0.05);<6个月组患儿肺动脉瓣保留率高于≥6月组患儿(65.52%对30.26%,P<0.01),住院天数少于≥6个月组患儿(11天对15天,P<0.01).术后随访中位数14.5个月(0.3~54.9个月),至末次随访时无再次手术干预,两组患儿随访时间、肺动脉瓣反流程度及残余梗阻差异均无统计学意义(P>0.05).结论婴儿早期实行法洛四联症根治手术效果满意,能提高手术中保留肺动脉瓣概率;建议法洛四联症择期治疗的年龄提前至6个月以内.Objective To investigate the timing of primary repair for tetralogy of Fallot based on pulmonary valve-sparing.Methods A retrospective analysis of the perioperative data of children undergoing primary repair for tetralogy of Fallot in our hospital between June 2015 and May 2019 was performed.To determinate cutoff value of pulmonary valve-sparing by using receiver operating characteristic curve(7?0C curve);the children were divided into two groups according to the age of cutoff value.The duration of postoperative mechanical ventilation,the length of hospital and ICU stay,emergency surgery rate,hospital mortality,31 day readmission rate,valve-sparing rate and fast-track rate and other indicators were compared between the two groups.Results A total of 105 children were enrolled according to the inclusion criteria,jncluding 67 males and 38 females,with a body mass of 4.21 kg to 21.5 kg,the median body mass was 7.9 kg,and age 1.3 months to 99.1 months,the median age lvas 8.8 months.Cutoff value of age for pulmonary valve-sparing was between 5.5 months and 5.6 months(sensitivity 0.90,specificity 0.58,95%Cl:0.588-0.792).Based on the age of 6 months,the children with tetralogy of Fallot were divided into two groups.There were no significant differences in duration of postoperative mechanical ventilation,length of ICU stay,emergency surgery rate,hospital mortality,31 day readmission rate and fast-track rate in<6 months group compared with those in M6 months group(P>0.05).The rate of valve-sparing in<6 months group was higher than that in A6 months group(65.52%vs.30.26%)(P<0.01),and the length of hospital stay was lower than that in M6 months group(ll days vs.15 days)(P<0.01).The median follow-up was 14.5 months(0.3-54.9 months),and there was no reoperation intervention at the last follow-up.There were no significant difference in the follow-up period,pulmonary regurgitation and residual obstruction between the two groups(P>0.05).Conclusion Therapeutic effect of elective early pnmary repair for tetralogy of Fallot in infan

关 键 词：法洛四联症 婴儿 保瓣 时机 

分 类 号：R726.5[医药卫生—儿科]