房间隔开窗在三尖瓣下移畸形矫治术中的效果分析  

The surgical effect of retained atrial shunt in Ebstein's anomaly

作　　者：李嘉晨 穆纯杰 章良 蒋显超 刘锦阳 张雅娟[1] 闫军[1] 李守军[1] 王强[1] LI Jia-chen;MU Chun-jie;ZHANG Liang;JIANG Xian-chao;LIU Jin-yang;ZHANG Ya-juan;YAN Jun;LI Shou-jun;WANG Qiang(Pediatric Cardiac Surgical Center National Center for Cardiovascular Diseases and Fmvai Hospital,CAMS and PUMC、Beijing 100037,China;Department of Cardiac Surgery,Fuwai Yunnan Cardiovascular Hospital,Kunming 650102,China)

机构地区：[1]中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院心脏外科,北京市100037 [2]云南省阜外心血管病医院心外科

出　　处：《中国心血管病研究》2021年第1期7-10,共4页Chinese Journal of Cardiovascular Research

基　　金：国家重点基础研究发展计划(2017YFC1308100)。

摘　　要：目的:总结并分析房间隔开窗在三尖瓣下移畸形矫治术中的效果。方法:连续收集2010年1月至2019年12月于中国医学科学院阜外医院确诊为三尖瓣下移畸形并接受双心室矫治手术的7岁以下患儿65例,并对生存率、再次手术率及三尖瓣返流情况等进行中期随访。结果:入组患儿中男性37人,女性28人,平均(3.99±2.13)岁。将患儿分为房间隔开窗组和未房间隔开窗组,两组在性别、年龄、体重、身长等基本情况,术前瓣膜返流程度,以及术后早期恢复情况如机械通气时间、ICU停留时间、住院时间等方面均无显著统计学差异(P<0.05),但两组间在早期再次手术比例上有显著性差异(P=0.003)。入组患儿整体随访率为96.9%,在中期随访中,开窗组的三尖瓣轻度返流比例显著高于非开窗组的轻度返流比例(P<0.001),同时重度返流比例显著低于非开窗组(P=0.037)。不同的双心室矫治方式上,开窗组和非开窗组中的Cone手术相较于Carpentier手术,三尖瓣中度(P=0.021)和重度返流P<0.001)的比例都明显更低。结论:相比于单纯双心室矫治,在双心室矫治基础上进行房间隔开窗,可以有效提高三尖瓣下移畸形矫治术的手术效果;Cone手术作为目前较为理想的双心室矫治手术方式,联合房间隔开窗,可能会取得较为理想的中期手术效果。Objective To summarize the outcome of retained atrial shunt in the correction of Ebstein's anomaly.Methods 65 children under 7 years old who were diagnosed with Ebstein's anomaly and underwent biventricular repair in Fuwai Hospital.Chinese Academy of Medical Sciences from January 2010 to December 2019 were collected consecutively.The survival rate,reoperation rate and tricuspid regurgitation were followed up in the mid-term.Results 37 male and 28 female were enrolled,with an average age of(3.99±2.13)years.Patients can be divided into retained atrial shunt group and non-retained atrial shunt group.Between the two groups in gender,age,weight,body length,such as basic situation,the degree of valvular regurgitation,preoperative and postoperative early recovery,such as mechanical ventilation,ICU stay time and length of hospital stay,etc,there was all no statistically significant difference(P>0.05),but in the early reoperation rate between the two groups there was significant difference(P=0.003).The overall follow-up rate of the enrolled children was 96.9%.In the mid-term follow-up,the proportion of mild tricuspid regurgitation in the retained atrial shunt group was significantly higher than that in the non-retained atrial shunt group(P<0.001)but the proportion of severe regurgitation was significantly lower than that in non-retained atrial shunt group(P=0.037).Compared with Carpentier procedure,the Cone procedure's rate of medium(P=0.021)and severe regurgitation(P<0.001)were significantly lower in both of two groups.Conclusion Compared with simple biventricular repair,retained atrial shunt on the basis of biventricular repair can effectively improve the surgical effect of Ebstein's anomaly.Cone procedure,as an ideal biventricular repair method at present,combining with retained atrial shunt may achieve an ideal mid-term surgical effect.

关 键 词：三尖瓣下移畸形 房间隔开窗 Cone手术 

分 类 号：R654.2[医药卫生—外科学]