新生儿及婴儿期主动脉弓中断合并室间隔缺损的手术疗效分析  

Surgical outcomes of interrupted aortic arch with ventricular septal defect in neonates and infants

作　　者：张文 蒋琪 朱奕帆 胡仁杰 郁夏风 董卫 朱宏斌 张海波[1] Zhang Wen;Jiang Qi;Zhu Yifan;Hu Renjie;Yu Xiafeng;Dong Wei;Zhu Hongbin;Zhang Haibo(Department of Cardiothoracic Surgery,Shanghai Children’s Medical Center,Shanghai Jiaotong University School of Medicine,Shanghai 200127,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,200127

出　　处：《中华胸心血管外科杂志》2021年第6期321-325,共5页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：浦东新区卫生系统重点学科群建设资助(PWZXQ2017-14)。

摘　　要：目的总结新生儿及婴儿期主动脉弓中断合并室间隔缺损(interrupted aortic arch with ventricular septal defect,IAA/VSD)的外科治疗策略和随访结果。方法回顾性分析我院2009年1月至2019年1月于新生儿及婴儿期手术的123例IAA/VSD患儿的临床资料。中位手术年龄48天,其中新生儿44例(36%)。122例(99%)患儿行标准主动脉弓重建+VSD修补术,1例(1%)新生儿行分期Yasui手术。利用决策树模型分析术后早期死亡的危险因素。结果术后早期死亡16例(13%)。体外循环>135 min、新生儿期接受手术、手术早于2016年的患儿死亡比例高。术后随访1~10年,中位随访时间为3.5年。术后半年、1年、5年免于发生主动脉弓残余梗阻率分别为75%、72%和72%,免于发生左心室流出道梗阻率分别为91%、83%和73%。术后17例患儿接受了21例次再手术。分期Yasui手术的患儿随访过程中无残余梗阻发生。结论新生儿、婴儿期IAA/VSD术后的早期效果满意。但是标准主动脉弓重建术后主动脉弓与左心室流出道梗阻发生率高,需要多次再手术解除梗阻。Objective To summarize the surgical outcomes of interrupted aortic arch with ventricular septal defect(IAA/VSD)in neonates and infants.Methods This was a retrospective review of clinical data of 123 neonates and infants who received surgery for IAA/VSD from Jan 2009 to Jan 2019.Median age at repair was 48 days.Forty-four patients(36%)were neonates.One-hundred-and-twenty-two patients(99%)underwent standard aortic arch reconstruction with VSD closure,and one neonate(1%)underwent staged Yasui operation.Risk factors for early mortality was analyzed by decision tree model.Results Early mortality after surgery was 13%.Duration of cardiopulmonary bypass longer than 135 min,surgery received during neonatal period and before 2016 was identified as higher risk group for mortality.Median follow-up time was 3.5 years(range,1-10 years).Freedom from aortic arch obstruction at 6 months,1 year,5 years after surgery was 75%,72%and 72%respectively.Freedom from left ventricular outflow tract(LVOT)obstruction at 6 months,1 year,5 years after surgery was 91%,83%and 73%respectively.A total of 17 patients received 21 reoperations.The patient who received Yasui operation experienced no residual obstruction during the follow-up.Conclusion Early outcomes after surgery for IAA/VSD in neonates and infants are satisfactory.However,patients with standard aortic arch reconstruction have a higher risk for aortic and LVOT obstruction,and require multiple reoperations.

关 键 词：主动脉弓中断 室间隔缺损 主动脉弓梗阻 左心室流出道梗阻 再手术 

分 类 号：R726.5[医药卫生—儿科]