房室间隔缺损矫治术后左侧房室瓣再次手术结果分析  

Results of reoperation of left atrioventricular valve after atrioventricular septal defect repair

作　　者：曹跃丰[1] 李磊[1] 苏俊武[1] 范祥明[1] Cao Yuefeng;Li Lei;Su Junwu;Fan Xiangming(Department of Pediatric Cardiac Center,Beijing Anzhen Hospital Capital Medical University,Beijing Institute of Heart Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院小儿心脏中心,北京市心肺血管疾病研究所,100029

出　　处：《中华胸心血管外科杂志》2021年第9期538-541,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的比较房室间隔缺损矫治术后左侧房室瓣反流再次手术的两种外科技术效果。方法回顾性分析2005年至2019年间28例房室间隔缺损术后左侧房室瓣反流再次手术的患儿病例。排除单心室、肺动脉环缩术后、心房异构和其他初期未处理左侧房室瓣的患儿。根据手术方式分为成形组与置换组,统计两组患儿术前基本资料和手术资料,分析术后早期结果和随访转归情况。两组数据的比较采用非参数检验和方差分析。将死亡与第3次等多次手术列为终点事件估计值,使用Kaplan-Meier方法进行回归分析。全部检验采用双尾法,P<0.05有统计学意义。结果28例患儿中男7例,女21例;年龄9.6岁(5.6~16.2岁),体质量28.55 kg(15.5~55.9 kg)。左侧房室瓣成形21例,左侧房室瓣置换7例。院内死亡2例,随访无死亡病例。再次手术后2例行第3次等多次手术。主动脉阻断时间置换组94 min(79~107 min)多于成形组66 min(45~83 min),P<0.05。瓣叶裂采用成形术18例,置换术2例(28.6%),P<0.05。随访1年生存率成形组94.4%,置换组85.7%;随访5年生存率成形组88.5%,置换组85.7%。结论左侧房室瓣反流是房室间隔缺损再次手术的主要原因。左侧房室瓣再次手术首选成形术,瓣膜置换作为次要选择。大多数瓣叶裂可以通过瓣膜成形修复。远期随访左侧房室瓣再次成形术后仍存在3次等多次手术风险。Objective This study aims to review two surgical techniques results of the reoperation for left atrioventricular valve(LAVV)failure in repaired atrioventricular septal defect.Methods All consecutive patients with repaired atrioventricular septal defect(AVSD)who underwent redo-LAVV surgery from 2005 to 2019 were included.Patients with single ventricles,banding,atrial isomerism,and complex associated anomalies were excluded.Univariate analysis included repair and replacement.Data analyzed included number and year of primary AVSD and redo-LAVV operation,morphology of AVSD,mortality,and reoperation,early and long-term survival.Results There were a total of 28 patients including 7 boys(25%)with age of 114.5 months(63.0-194.5 months).The mean body weight was 28.55 kg(15.5-55.9 kg).There were 11(39.3%)patients with complete AVSD and 17(60.7%)with partial AVSD,and 21(75%)patients with LAVV valvuloplasty(LAVVP),7(25%)patients with LAVV replacement(LAVVR).The aortic cross clamp time was significantly longer in patients who underwent LAVVR compared to LAVVP[LAVVR 94 min(79-107)min vs.LAVVP 66 min(45-83 min),P<0.05].The technique of cleft closure with LAVVP 18(87.5%)more than LAVVR 2(28.6%),P<0.05.Conclusion The postoperative left atrio-ventricular valve(LAVV)regurgitation is the main reason of the reoperation.The technique of cleft closure with LVVR-Repair is favorable.At follow-up,survivors with re-LVVR-Repair have high rates with numerous operations.

关 键 词：房室间隔缺损 左侧房室瓣反流 左侧房室瓣再次手术 

分 类 号：R726.5[医药卫生—儿科]