完全性大动脉转位患儿300例动脉调转术后结果及随访分析  

Clinical outcomes and follow-up results of 300 cases of transposition of great arteries intervened by the arterial switch operation

作　　者：谭玉玉 潘微 庞程程 申俊君 庄建[3] 温树生[3] 孙云霞 Tan Yuyu;Pan Wei;Pang Chengcheng;Shen Junjun;Zhuang Jian;Wen Shusheng;Sun Yunxia(Department of Neonatal Intensive Care Unit,Guangdong Provincial People′s Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510080,China;Department of Maternal-Fetal Cardiology,Guangdong Cardiovascular Institute,Guangdong Provincial People′s Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510080,China;Department of Cardiac Surgery,Guangdong Cardiovascular Institute,Guangdong Provincial People′s Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510080,China)

机构地区：[1]广东省人民医院(广东省医学科学院)新生儿重症监护室,广州510080 [2]广东省人民医院(广东省医学科学院)广东省心血管病研究所胎儿心脏诊疗科,广州510080 [3]广东省人民医院(广东省医学科学院)广东省心血管病研究所心外科,广州510080

出　　处：《中华实用儿科临床杂志》2022年第7期521-525,共5页Chinese Journal of Applied Clinical Pediatrics

基　　金：国家重点研究发展计划资助(2018YFC1002602)。

摘　　要：目的总结分析300例完全性大动脉转位(TGA)患儿动脉调转术的诊治经验及随访结果。方法本研究为单中心回顾性研究,收集2010年1月至2017年12月于广东省人民医院完成动脉调转术治疗的300例TGA患儿的临床资料。男236例,女64例;年龄(23.8±39.2)d,体质量(3.5±0.8)kg。合并室间隔缺损的TGA(TGA/VSD)128例(42.7%),室间隔完整的TGA(TGA/IVS)172例(57.3%)。冠状动脉正常193例(64.3%),合并冠状动脉畸形107例(35.7%),其中术中探查发现壁内走行的冠状动脉21例(7.0%),单支冠状动脉17例(5.7%)。本研究计量资料为非正态分布,采用Mann-Whitney U秩和检验,计数资料采用χ2检验或Fisher′s确切概率法,总体生存率采用Kaplan-Meier分析,组间比较采用Log Rank检验。结果患儿均完成手术。在出生3周内手术的TGA/IVS患儿占73.3%,在出生3个月内手术的TGA/VSD患儿占85.9%。体外循环时间(193±68)min,主动脉阻断时间(122±39)min。围术期死亡25例(8.3%)。术后发生低心排血量综合征30例;因Ⅲ度房室传导阻滞植入永久起搏器1例。出院后成功随访254例,随访时间1个月~10年(中位随访时间4.3年),随访期间死亡3例,均为单支冠状动脉。5年、10年生存率均为90.7%。肺动脉狭窄49例(49/254例,19.3%),主动脉瓣返流66例(66/254例,26.0%),肺动脉瓣返流47例(47/254例,18.5%),主动脉吻合口狭窄4例(4/254例,1.6%)。21例(21/254例,8.3%)患儿需要再次干预,4例拒绝再次干预,实际干预17例(17/254例,6.7%),共18次干预,其中肺动脉狭窄矫治术12次,经皮介入治疗肺动脉狭窄4次,主动脉吻合口狭窄矫治术1次,更换永久起搏器1例。结论动脉调转术是治疗TGA的最有效方法,其远期随访结果令人满意,远期再手术风险低。Objective To summarize and analyze the efficacy,experience and follow-up results of 300 cases of transposition of the great arteries(TGA)intervened by arterial switch operation.Methods It was a retrospective,single-center study involving 300 TGA patients intervened by arterial switch operation between January 2010 and December 2017 in Guangdong Provincial People′s Hospital.Their clinical data were retrospectively analyzed.There were 236 male patients and 64 females.Among them,128 cases(42.7%)were TGA with ventricular septal defect(TGA/VSD),and 172 cases(57.3%)were TGA with intact ventricular septal defect(TGA/IVS).The mean age and weight at operation were(23.8±39.2)cases days,and(3.5±0.8)kg,respectively.There were 193 cases(64.3%)with usual coronary artery patterns,and 107 cases(35.7%)with unusual coronary artery patterns.Among the 107 cases with unusual coronary artery patterns,21 cases(7.0%)were involved with the intramural coronary artery,and 17(5.7%)presented the single-ostium coronary pattern.Non normal distribution data were used the Mann-Whitney U test.Categorical measures were compared by Chi-square test or Fisher′s exact test.Survival probability and freedom from events were calculated by the Kaplan-Meier method,and difference in survival probability by the Log Rank test.Results All patients were successfully intervened by arterial switch operation,73.3%of patients with TGA/IVS underwent the surgery within 3 weeks after birth,and 85.9%of patients with TGA/VSD underwent surgery within 3 months.The mean cardiopulmonary bypass time and aortic occlusion time were(193±68)min,and(122±39)min,respectively.Twenty-five patients(8.3%)died in hospital.Thirty cases had low cardiac output syndrome,1 implanted with a permanent pacemaker due to complete atrioventricular block.A total of 254 patients were followed up for 1 month to 10 years.Three patients with single-ostium coronary pattern died at the follow-up period.The 5-year and 10-year survival rates were both 90.7%.During the follow-up,49 cases(49/254 case

关 键 词：动脉调转术 完全性大动脉转位 随访 

分 类 号：R726.5[医药卫生—儿科]