先天性房室间隔缺损的外科治疗临床分析  

Clinical analysis of surgical treatment of congenital atrioventricular septal defect

作　　者：石卓[1] 邱芸香[1] 李建华[1] 齐建川[1] 俞劲[1] 舒强[1] Shi Zhuo;Qiu Yunxiang;Li Jianhua;Qi Jianchuan;Yu Jin;Shu Qiang(Heart Center,Affiliated Children's Hospital,Zhejiang University School of Medicine,National Clinical Research Center for Children's Health,Hangzhou 310052,China)

机构地区：[1]浙江大学医学院附属儿童医院心脏中心,国家儿童健康与疾病临床医学研究中心,杭州310052

出　　处：《中华小儿外科杂志》2021年第12期1084-1089,共6页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨先天性房室间隔缺损(atrioventricular septal defect,AVSD)的中长期外科治疗效果及再次手术的危险因素。方法回顾性分析2009年1月至2019年12月收治于浙江大学医学院附属儿童医院的125例先天性房室间隔缺损患儿的临床资料。其中,男46例,女79例;完全型房室间隔缺损(complete atrioventricular septal defect,C-AVSD)72例,部分型房室间隔缺损(partial atrioventricular septal defect,P-AVSD)34例,过渡型房室间隔缺损(intermediate atrioventricular septal defect,I-AVSD)19例;中位手术年龄为14个月。根据解剖分型分别采用房间隔缺损修补、房室瓣整形、改良单片法、双片法进行手术治疗。统计患儿的病死率、再手术率。采用单因素、多因素相关性分析及Cox回归分析患儿病死率及再手术危险因素。结果所有患儿均顺利完成体外循环下房室间隔缺损修补+房室瓣成形术,体外循环时间为(102±35)min,主动脉阻断时间为(67±26)min,呼吸机辅助时间为(35±18)h,术后住院时间为(13.8±4.5)d。术后并发症包括低心排8例,左房室瓣重度反流3例,左房室瓣反流伴狭窄1例,房间隔残余分流1例,左室流出道狭窄1例,心律失常1例,颅内出血1例,肺部感染7例(其中重症肺炎1例),脓毒症2例。术后总病死率为6.4%(8/125),近五年(2015~2019年)病死率为4.3%(2/46)。死亡病例的病理分型为C-AVSD5例,I-AVSD 1例,P-AVSD 2例;其中死于低心排血量综合征3例,脓毒症2例,心律失常1例,颅内出血1例,重症肺炎1例。再手术率为6.4%(8/125),其中早期手术(住院期间或出院后30 d内)6例,包括左侧房室瓣反流3例,左室流出道狭窄1例,心律失常1例,颅内出血1例;晚期手术(出院30 d后)2例,均为左侧房室瓣重度反流,其中1例合并左侧房室瓣狭窄。再次手术的Cox回归分析结果显示合并左房室瓣发育不良的AVSD患儿再次手术的风险是不合并左房室瓣发育不良的5.212倍(95%置信区间:1.151~23.60Objective To retrospectively explore clinical features,surgical treatments,mid/long-term survival rates and risk factors for reoperation in children with congenital atrioventricular septal defect(AVSD).Methods From January 2009 to December 2019,125 hospitalized children(46 boys,79 girls)were operated.There were complete atrioventricular septal defect(C-AVSD,n=72),partial atrioventricular septal defect(P-AVSD,n=34)and intermediate atrioventricular septal defect(I-AVSD,n=19).The median operative age was 14 months.According to anatomical classifications,atrial defect repair,atrioventricular valve reshaping and modified mono/double-patching were performed.Demographic data,in-hospital mortality and reoperation rate were recorded.Univariate/multivariate correlation and Cox regression analyses were performed.Results Atrioventricular septal defect repair and atrioventricular valvuloplasty were successfully performed under cardiopulmonary bypass with cardiopulmonary bypass time(102±35)min,aortic arrested time(67±26)min,ventilator assist time(35±18)hours and postoperative hospitalization stay(13.8±4.5)days.Postoperative complications included low cardiac output(n=8),severe left atrioventricular valve regurgitation(n=3),left atrioventricular valve regurgitation with stenosis(n=1),residual atrial septal shunt(n=1),left ventricular outflow tract stenosis(n=1),arrhythmia(n=1),intracranial hemorrhage(n=1),lung infection(n=7,including 1 case of severe pneumonia)and sepsis(n=2).Overall postoperative mortality rate was 6.4%(8/125)and mortality rate 4.0%(2/46)in the past 5 years.All death cases belonged to C-AVSD and death cause was low cardiac output syndrome(n=3),sepsis(n=2),arrhythmia(n=1),intracranial hemorrhage(n=1)and severe pneumonia(n=1).The reoperative rate was 6.4%(8/125),including early operation(n=6,during hospitalization or within 1 month post-discharge),including left atrioventricular regurgitation(n=3),left ventricular outflow tract obstruction(n=1)and arrhythmia(n=1),intracranial hemorrhage(n=1);late operation f

关 键 词：心脏病 房室瓣 房室间隔缺损 

分 类 号：R726.5[医药卫生—儿科]