摘要
目的回顾性评价Sutureless技术在新生儿完全性肺静脉异位引流(total anomalous pulmonary venous connection,TAPVC)的单中心外科矫治情况。方法纳入2002年9月至2015年12月在我院行心上、心下型完全性肺静脉异位引流外科矫治的新生儿患者71例,男57例(80.3%),女14例(19.7%);中位手术年龄是8(1,29)d,中位体重3.3(2.1,4.7)kg。根据Darling分型,其中心上型45例(63.4%),心下型26例(36.6%)。根据手术方式将患者分为传统手术组(29例)和Sutureless技术组(42例),采用倾向性评分匹配两组资料。结果采用倾向性评分匹配后两组术前资料差异无统计学意义。死亡18例(25.4%),其中术后早期死亡11例(15.5%),晚期死亡7例(9.6%)。传统手术组死亡率(58.6%,17/29)高于Sutureless技术组(2.4%,1/42),差异有统计学意义(P=0.000)。Kaplan-Meier生存曲线示两组死亡率差异有统计学意义(P=0.005)。随访25.5(1.0~130.0)个月。随访时发生吻合口狭窄12例,其中传统手术组11例(37.9%),Sutureless技术组1例(2.4%),两组差异有统计学意义(P=0.000)。术后发生吻合口狭窄12例,其中8例患儿死亡,其死亡率高于术后吻合口通畅患儿[66.7%(8/12)vs.16.9%(10/59),P=0.001],差异有统计学意义。结论在新生儿TAPVC的矫治中,患者术后死亡与TAPVC术后吻合口狭窄明显相关,与传统手术方式相比,Sutureless技术可有效降低新生儿TAPVC术后吻合口狭窄发生率及死亡率。
Objective To analyze the sutureless technique use in the surgical repair for total anomalous pulmonary venous connection in neonates. Methods Between September 2002 and December 2015, 71 consecutive neonates with supracardiac or infracardiac type total anomalous pulmonary venous connection who underwent surgical repair in our institute were included in this study. There were 57 males and 14 females at median age of 8 （1, 29） d. And the median body weight was 3.3 （2.1, 4.7） kg. There were 45 patients （63.4%） with supracardiac, 26 patients （36.6%） with infracardiac. Patients were divided into two groups： a conventional technique group （29 patients） and a sutureless technique group （42 patients）. To control for potential differences in the characteristics of patients between the sutureless technique group and the conventional technique group, the method of propensity-score matching was used. Results Basic characteristics of patients after propensity-score were not different.There were 11 operative deaths （15.5%）, 7 late deaths （96.%）, total 18 deaths （25.4%）. The mortality was 58.6% （17/29） in the conventional technique group, 2.4% （1/42） in the sutureless technique group （P=0.000）. Kaplan-Meier survival curve showed a difference in mortality between the two groups （P=0.005）. The patients were followed up for 25.5 （1.0-13.0） months.Postoperative anastomotic or pulmonary vein stenosis occurred in patients with smooth anastomosis [66.7% （8/12） vs 12 patients, 8 of them died at a higher mortality than that of the 16.9% （10/59）, P=0.001]. Conclusion The patients who have postoperative anastomotic or pulmonary vein stenosis have higher mortality. Compared with conventional technique, sutureless technique can dramatically decrease the incidence of postoperative anastomotic or pulmonary vein stenosis and the mortality of surgical repair for total anomalous pulmonary venous connection in neonates.
出处
《中国胸心血管外科临床杂志》
CAS
CSCD
2017年第9期661-666,共6页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
基金
“十二五”国家科技支撑计划项目(2011BAIB22)
