改良Blalock-Taussig分流术与右心室流出道支架植入术姑息性治疗法洛四联症的比较

Comparison between the modified Blalock-Taussig shunt and right ventricular outflow tract stent in the palliative treatment for tetralogy of Fallot

目的:对于不适合一期根治或手术风险高的法洛四联症(tetralogy of Fallot,TOF)患者,经导管右心室流出道(right ventricular outflow tract,RVOT)支架植入术是一种安全有效的姑息干预方式。本研究旨在探讨RVOT支架植入术和改良Blalock-Taussig分流术(modified Blalock-Taussig shunt,mBTS)在TOF新生儿和婴儿期患者中的治疗效果,并比较2种姑息干预方式对患儿动脉血氧饱和度及肺动脉发育的影响。方法:回顾性收集中南大学湘雅二医院于2011年3月至2021年3月收治的32例TOF患者的临床资料。根据接受的手术方式,将患者分为行RVOT支架植入术的支架植入组(n=15)和行mBTS术的mBTS组(n=17),评估和比较2组患者的动脉血氧饱和度、术后并发症发生率、病死率、再干预率等,根据超声心动图结果,使用z-评分评估患者的肺动脉干、右肺动脉及左肺动脉的发育情况。结果:与mBTS组相比,支架植入组患儿的年龄较小,体重较低(均P<0.05)。与术前相比,支架植入组术后患儿的动脉血氧饱和度明显升高[(75±17)%vs(96±3)%,P=0.026],肺动脉干[(−2.82±1.27)分vs(0.86±0.77)分,P=0.014]、右肺动脉[(−1.88±0.59)分vs(−0.28±0.71)分,P=0.011]及左肺动脉[(−2.34±0.36)分vs(−1.67±0.36)分,P=0.036]的z-评分明显增加。而mBTS组患儿术前与术后的动脉血氧饱和度以及肺动脉z-评分的差异均无统计学意义(均P>0.05)。结论:RVOT支架植入术对低出生体重、伴有严重合并症的TOF患儿具有良好的手术效果;与mBTS相比,RVOT支架植入术术后患儿的动脉血氧饱和度更高且肺动脉发育更好。

Objective:For patients with tetralogy of Fallot(TOF)who are not suitable candidates for primary corrective surgery or have a high surgical risk,transcatheter right ventricular outflow tract(RVOT)stent implantation is considered a safe and effective palliative intervention.This study aims to investigate the therapeutic outcomes of RVOT stent implantation in neonates and infants with TOF in comparison with the modified Blalock-Taussig shunt(mBTS)and to compare the impact of the 2 palliative interventions on arterial oxygen saturation and pulmonary artery development in pediatric patients.Methods:Clinical data of 32 patients with TOF admitted to the Second Xiangya Hospital of Central South University from March 2011 to March 2021 were retrospectively collected.The patients were divided into an mBTS group(undergoing mBTS,n=15)and a stent implantation group(undergoing RVOT stenting,n=17)according to the surgical procedures.The 2 groups were assessed and compared in the surgical-related arterial oxygen saturation,postoperative complication rate,mortality rate,and re-intervention rate.The development of the patients’main pulmonary artery,right pulmonary artery,and left pulmonary artery was assessed by z-scores according to echocardiographic results.Results:The children in the stent implantation group were younger and less weighed compared with the mBTS group(both P<0.05).Compared with the preoperative period,children in the stent implantation group had significantly higher arterial oxygen saturation[(75±17)%vs(96±3)%,P=0.026];z-scores of pulmonary trunk[(-2.82±1.27)points vs(0.86±0.77)points,P=0.014],right pulmonary artery[(-1.88±0.59)points vs(-0.28±0.71)points,P=0.011],and left pulmonary artery[(-2.34±0.36)points vs(-1.67±0.36)points,P=0.036]were significantly increased.However,there were no significant differences in arterial oxygen saturation and pulmonary artery z-scores between pre-and post-mBTS procedures(all P>0.05).Conclusion:RVOT stent would have good surgical outcomes used in TOF patients with low weight and severe comorbidities.It also leads to an higher postoperative oxygen saturation and better promotion of pulmonary artery growth with RVOT stent compared to mBTS.