145例先天性主动脉瓣狭窄外科治疗的回顾性队列研究  

Outcomes of surgical treatment for congenital aortic stenosis in 145 children: A retrospective cohort study

作　　者：朱奕帆 蒋琪 张文 胡仁杰 郁夏风 张海波[1] ZHU Yifan;JIANG Qi;ZHANG Wen;HU Renjie;YU Xiafeng;ZHANG Haibo(Department of Cardiothoracic Surgery,Shanghai Children's Medical Center,Shanghai Jiao Tong University School of Medicine,Shanghai,200127,P.R.China)

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

出　　处：《中国胸心血管外科临床杂志》2021年第6期675-681,共7页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：上海聚德慈善基金。

摘　　要：目的探讨本中心先天性主动脉瓣狭窄外科修复术的诊疗要点。方法回顾性分析2008~2019年于我院接受主动脉瓣成形术治疗的145例先天性主动脉瓣狭窄患儿的临床资料,其中男104例、女41例,中位年龄2.9(0.6,7.8)岁。记录并分析患儿术前资料、术中资料、近远期瓣膜功能、远期生存率、免于再手术率和免于主动脉瓣置换率。结果手术行单纯交界切开120例,瓣叶补片成形术15例,主动脉瓣置换25例。平均随访0.25~11.20(4.2±2.8)年,10年生存率92.3%,10年免于再手术率63.2%,10年免于主动脉瓣置换率60.4%。多因素风险分析提示:使用补片成形是再次手术的独立风险因素(P=0.036),术前有球囊扩张史(P=0.029)和术前显著反流(P=0.001)是接受主动脉瓣置换的风险因素。结论外科手术治疗先天性主动脉瓣是一种安全有效的方法,为后期进一步治疗策略的制定提供足够的时间,以获得更明确的治疗策略。术中使用补片会增加再手术风险,术前有球囊扩张史和术前显著的主动脉瓣反流会增加接受主动脉瓣置换的风险。Objective To explore the experience of surgical repair for congenital aortic stenosis(AS)in our center.Methods We retrospectively reviewed the clinical data of 145 children diagnosed with AS,who underwent aortic repair from 2008 to 2019,with or without aortic insufficiency(AI),including 104 males and 41 females with a median age of 2.9(0.6,7.8)years.The preoperative and intraoperative data,early and long-term valvular function,long-term survival rate and freedom from reoperation and aortic valve replacment(AVR)were analyzed.Results There were 120 patients receiving commissurotomy,15 valvuloplasty with extra pericardium patch,and 25 AVR.The mean follow-up time was0.25-11.20(4.2±2.8)years.Survival rate at 10 years was 92.3%.Freedom from reoperation and AVR was 63.2%and 60.4%respectively.Multivariate analysis revealed that using a patch during surgery(P=0.036)was an independent risk factor for reoperation.A history of preoperative balloon dilation(P=0.029)and significant preoperative AI(P=0.001)contributed to AVR.Conclusion Surgical treatment of congenital aortic valve stenosis in children is a safe and effective method that provides enough time to achieve a more definitive solution.Using a patch during surgery increases reoperation hazard.A history of previous balloon dilation and significant preoperative AI may result in AVR during the follow-up.

关 键 词：先天性主动脉瓣狭窄 主动脉瓣关闭不全 主动脉瓣置换 外科手术 

分 类 号：R654.2[医药卫生—外科学]