先天性矫正型大动脉转位解剖纠治术与Fontan术后早中期结果的单中心回顾性队列研究  

Early and mid-term results of Fontan operation versus anatomic correction for congenitally corrected transposition of the great arteries:A retrospective cohort study in a single center

作　　者：王涛[1] 陈欣欣[1] 邹明晖[1] 曲江波 WANG Tao;CHEN Xinxin;ZOU Minghui;QU Jiangbo(Heart Center,Guangzhou Women and Children's Medical Center,Guangzhou Medical University,Guangzhou,510623,P.R.China)

机构地区：[1]广州医科大学附属广州市妇女儿童医疗中心心脏中心,广州510623

出　　处：《中国胸心血管外科临床杂志》2023年第9期1308-1315,共8页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：广东省出生缺陷重点实验室(2019B020227001);广州市高水平临床重点专科项目(011102-02)。

摘　　要：目的比较接受解剖纠治术和Fontan术的先天性矫正型大动脉转位(congenitally corrected transposition of the great arteries,ccTGA)患者的早中期预后。方法回顾性分析2009年1月—2021年9月在广州医科大学附属广州市妇女儿童医疗中心接受治疗53例ccTGA患者的临床资料,其中男41例、女12例,根治术时年龄55.02(3~168)个月。根据手术方式将患者分为解剖纠治组(16例)和Fontan组(37例),对两组患儿术后生存率、并发症、免于再干预率等进行比较。另招募180名健康儿童作为对照组,采用倾向性评分匹配方法匹配14名儿童进入Fontan对照组。比较Fontan组和Fontan对照组心肺运动试验(cardiopulmonary exercise testing,CPET)结果。结果解剖纠治组早期死亡2例(12.5%),早期再干预3例(18.8%),9例(56.3%)并发心律失常;Fontan组早期死亡1例(2.7%),早期再干预2例,6例(16.2%)并发心律失常。与解剖纠治组相比,Fontan组的体外循环时间、主动脉阻断时间、气管插管时间及住ICU时间缩短,差异有统计学意义(P<0.05)。CPET结果:Fontan组的最大摄氧量占预测值百分比(VO2max%)明显低于Fontan对照组(0.84±0.11 vs.0.99±0.12,P<0.05)。术后随访0.5~126.0个月,失访2例,均为Fontan组;两组中期均无死亡,解剖纠治组因Ⅲ度房室传导阻滞再干预1例,Fontan组无再干预。解剖纠治组术后1年、5年、10年的无移植生存率均为87.5%,Fontan组均为97.3%(P>0.05)。末次随访时48例(100.0%)心功能分级均为Ⅰ/Ⅱ级。结论在ccTGA的外科治疗中,解剖纠治术或Fontan术的无移植生存率无明显差异,但Fontan组的术后并发症发生率相对更低。即使患者满足解剖纠治的条件,Fontan术也可纳入考虑范围。Objective To compare the early and mid-term results between Fontan operation and anatomic correction for congenitally corrected transposition of the great arteries(ccTGA).Methods The clinical data of 53patients with ccTGA who underwent anatomic correction and Fontan operation from January 2009 to September 2021 in our hospital were reviewed,including 41 males and 12 females with a mean age of 55.02(3-168)months.They were divided into an anatomic correction group(16 patients)and a Fontan operation group(37 patients)according to the operation.The hospitalization mortality,survival rate,postoperative complications,and free rate from re-intervention between the two groups were compared.Another 180 healthy children were recruited as a control group,and 14 children were matched with the propensity score matching method as a Fontan control group.The results of cardiopulmonary exercise testing(CPET)between the Fontan operation group and the Fontan control group were compared.Results There were 2(12.5%)early deaths and 3(18.8%)early re-intervention in the anatomic correction group,while 1death and 2 re-intervention in the Fontan operation group.In addition,there were 9 patients(56.3%)in the anatomic correction group and 6(16.2%)patients in the Fontan operation group suffering from arrhythmia after operation,respectively.Compared with the anatomic correction group,cardiopulmonary bypass time,aortic cross-clamping time,intubation time and ICU stay were significantly shortened in the Fontan operation group(P0.05).CPET results showed that,percent predicted max VO2 in the Fontan operation group was lower than that in the Fontan control group(0.84±0.11 vs.0.99±0.12,P0.05).The patients were followed up for 0.5-126.0 months.Two patients were lost in the Fontan operation group.There was no death and 1 re-intervention in the anatomic correction group,while no death or reintervention in the Fontan operation group.The 1-year,5-year and 10-year transplant-free survival rate of the anatomic correction group and the Fontan operation g

关 键 词：先天性矫正型大动脉转位 解剖纠治 FONTAN术 心肺运动试验 

分 类 号：R654.2[医药卫生—外科学]