三尖瓣下移畸形锥形重建27例分析  

Analysis of 27 cases of conical reconstruction of tricuspid valve depression

作　　者：胡根源 郑景浩[2] 祝忠群[2] 何晓敏 潘燕军 施国承 罗凯 Hu Genyuan;Zheng Jinghao;Zhu Zhongqun;He Xiaomin;Pan Yanjun;Shi Guocheng;Luo Kai(Department of Cardiovascular Surgery,Anhui Children's Hospital,Hefei 230051,China;Department of Cardiothoracic Surgery,Shanghai Children's Medical Center,Shanghai 200127,China)

机构地区：[1]安徽省儿童医院心血管外科,合肥230051 [2]上海交通大学医学院附属上海儿童医学中心心胸外科,上海200127

出　　处：《中华小儿外科杂志》2023年第9期806-810,共5页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨锥形重建手术治疗三尖瓣下移畸形的疗效和同期行Glenn手术影响因素。方法收集2020年1月至2022年12月上海交通大学医学院附属上海儿童医学中心心胸外科收治的27例三尖瓣下移畸形行三尖瓣锥形重建术患儿的临床资料,其中男11例,女16例;中位年龄为49.75个月,中位形重为19.84 kg。合并房间隔缺损15例,室间隔缺损1例,卵圆孔未闭6例,预激综合征2例。随访观察椎形重建临床效果,比较单纯行椎形重建术与椎形重建加行Glenn术患儿的主动脉阻断时间、体外循环时间、隔瓣及后瓣下移程度,采用logistic单因素及多因素回归分析。结果患儿均行三尖瓣锥形重建手术治疗,同期行房化心室折叠术26例,同期行上腔静脉与右肺动脉双向分流术(Glenn手术)6例。房缺修补术14例,卵圆孔未闭修补术6例,室缺修补术1例,保留房间隔缺损2例。术后随访1~36个月,25例治疗痊愈,心功能明显改善,疗效满意;死亡2例,1例心功能衰竭合并颅内出血,1例低心排综合症。单纯行椎形重建术与同期加行Glenn术的患儿在性别、年龄、体重、体外循环时间、主动脉阻断时间、下移隔瓣和下移后瓣方面的差异均无统计学意义(P>0.05),且单因素及多因素logistic回归分析结果显示以上因素均不是加行Glenn术的影响因素。结论三尖瓣锥形重建术在恢复三尖瓣的位置和功能方面疗效较好,是治疗三尖瓣下移畸形的一种有效措施。Objective To explore the efficacy of conical reconstruction for tricuspid valve(TV)deformity and to examine the influencing factors of Glenn operation.Methods From January 2020 to December 2022,the relevant clinical data were collected from 27 children undergoing conical reconstruction of TV at Shanghai Children's Medical Center.There were 11 boys and 16 girls with a median age of 49.75 months and a median body weight of 19.84 kilogram.There were atrial septal defect(n=15),ventricular septal defect(n=1),patent foramen ovale(n=6)and preexcitation syndrome(n=2).Aortic occlusion time,cardiopulmonary bypass time and descending degree of septum/posterior flap were compared between children undergoing vertebral body weight reconstruction alone and those undergoing Glenn operation.Logistic univariate and multivariate regression analyses were performed.Results Atrial folding(n=26)and bilateral shunt between superior vena cava and right pulmonary artery(Glenn operation,n=6)were performed.There were atrial defect repair(n=14),patent foramen ovale repair(n=6),ventricular defect repair(n=1)and atrial septal defect preservation(n=2).During a follow-up period of(1-36)months,25 cases were cured,cardiac function obviously improved and curative outcome was satisfactory.There were mortality(n=2),heart failure with intracranial hemorrhage(n=1)and low cardiac output syndrome(n=1).No significant differences existed in gender,age,body weight,cardiopulmonary bypass time,aortic occlusion time or descending septal/posterior flap between children undergoing vertebral reconstruction alone and those undergoing simultaneous Glenn surgery(P>0.05).The results of univariate and multivariate Logistic regression analysis indicated that the above factors were not influencing factors for Glenn's operation.Conclusions Conical reconstruction of TV is effective in restoring its position/function.It is indicated for Ebstein malformation.

关 键 词：心脏缺损 先天性 三尖瓣 三尖瓣成形术 

分 类 号：R726.5[医药卫生—儿科]