摘要
目的探索永存动脉干患儿外科矫治的早中期结果。方法回顾性分析2009年11月至2018年5月27例在我科接受外科治疗的永存动脉干患儿的临床资料、外科手术方法、早期死亡率及中期随访结果。其中男14例、女13例。接受手术中位年龄3个月(13 d至11岁),>6个月者10例(37.0%)。中位体重5.4(3.2～21.2)kg。结果手术死亡3例(死亡率11.1%),30 d存活率88.9%。手术主要并发症包括室间隔开窗2例,Ⅲ°房室传导阻滞1例。存活患儿平均随访时间1～76(24.5±19.3)个月,随访期死亡3例,失访2例。随访发现:中度及以上肺动脉狭窄7例,包括肺动脉主干狭窄3例,左右肺动脉开口狭窄各2例;中度主动脉瓣反流1例。全组暂无再次干预病例。1年和5年生存率均为76.1%(95%CI 59.2%～92.9%)。结论永存动脉干的治疗仍面临挑战。早期一期根治手术风险较低,早中期效果满意;而患儿年龄偏大,合并重度肺动脉高压和/或共干瓣反流者,死亡风险较高。部分患儿仍存在较高的晚期右心室流出道或左/右肺动脉分支再梗阻风险,需要密切随访。
Objective To evaluate the early-and mid-term outcomes of surgical repair of persistent truncus arteriosus in children in a single institution of China. Methods The clinical data of 27 consecutive patients with persistent truncus arteriosus undergoing surgical repair in Guangzhou Women and Children’s Medical Center from November 2009 to May 2018 were retrospectively reviewed. There were 14 males and 13 females. Median age was 3.0 months(range: 13 days-11 years), of whom 10(37.0%) were older than 6 months. Results There were three early deaths with a mortality of 11.1%. The main complications included VSD partial repair in 2 patients, complete atrioventricular block in one patient. The mean follow-up time was 24.5±19.3 months(range: 1–76 months). There were three late deaths, and two patients lost follow. Echocardiology showed seven patients of right heart outflow tract obstruction,including three in pulmonary artery trunk, and four of pulmonary artery branches. One patient showed moderate aortic valve regurgitation. None required re-intervention during the follow-up. Survival estimates for the entire cohort following surgery were both 76.1%(95%CI 59.2% to 92.9%) at 1 year and 5 years. Conclusion The surgical repair of persistent truncus arteriosus(PTA) remains challenges. The early-and mid-term outcomes of surgical repair of persistent truncus arteriosus are acceptable. For older children with severe pulmonary artery hypertension and/or trunk valve regurgitation, the risk of death is still higher. Some children have the higher risk of late right heart obstructive lesions.
作者
邹明晖
马力
夏园生
杨盛春
陈伟丹
李文雷
陈欣欣
ZOU Minghui;MA Li;XIA Yuansheng;YANG Shengchun;CHEN Weidan;LI Wenlei;CHEN Xinxin(Department of Cardiac Surgery,Guangzhou Women and Children's Medical Center,Guangzhou Medical University,Guangzhou,510623,P.R.China)
出处
《中国胸心血管外科临床杂志》
CAS
CSCD
2019年第4期321-325,共5页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
关键词
永存动脉干
右室流出道重建
共干瓣反流
早中期结果
Persistent truncus arteriosus
right ventricular outflow tract reconstruction
early- and mid-term results
