动脉调转术不同年龄手术效果的对比——附142例错过最佳手术年龄者治疗经验

A comparative study between the operation age and result of 264 cases of arterial switch operation-a report of surgical experience of 142 patients who had missed optimal operation age

目的探讨大动脉转位（TGA）病儿接受动脉调转手术（ASO）时年龄对手术效果的影响。方法2000年5月至2008年9月，264例TGA病儿行ASO。男194例，女70例；年龄1d～19岁。其中室隔完整型TGA（TGA／IVS）84例；年龄≤2周28例，〉2周56例。伴室隔缺损TGA（TGA／VSD）130例，Tamsing-Bing畸形（TBA）50例，其中≤6月94例，〉6月86例。符合最佳手术年龄（≤2周TGA／IVS，≤6个月TGA／VSD、TBA）者122例，错过最佳手术年龄者（〉2周TGA／IVS，〉6个月TGA／VSD、TBA）142例。手术方法：18例〉2周TGA／IVS先期行左室训练，4例〉6个月TGA／VSD先期行肺动脉环缩，余者均一期行ASO，同期矫治合并畸形。结果全组手术死亡26例，病死率9．85％。平均随访（29．5±7．6）个月，2例分别于术后2个月和1．5年猝死，1例术后1．5年因肺动脉吻合口狭窄再次手术，余者心功能明显改善，无死亡和远期并发症发生。符合最佳手术年龄者病死率13．11％；错过最佳手术年龄者病死率7．04％。2006年后（共154例），TGA病儿病死率由19．09％降至3．25％（P〈0．05），符合最佳手术年龄者由22．64％降至5．80％（P〈0．05），错过最佳手术年龄者由15．79％降至1．18％（P〈0．05）。结论ASO应用于错过最佳手术年龄TGA者亦可取得满意效果。

Objective To investigate and compare the impact of the operation age on the surgical resuh in patients who received the arterial switch operation（ASO）. Methods The ASO proeesure was performed in 264 consecutive patients（ 194 males and 70 females） from May 2000 to September 2008. 84 patients were diagnosed as transposition of the great arteries with intact ventrietdar septal （TGA/IVS）, 28 of them were ≤2 weeks of age, 56 of them were 〉 2 weeks of age. 180 patiens were diagonosed as transposition of the great arteries with ventrieular septal defect（TGA/VSD, 130 cases） or Tausaing-Bing anomaly（TBA, 50 eases） . Among all the TGA/VSD and TBA patients, the age of 94 of them were≤6 months, 86 of them were 〉 6 months. According to the operation age, 122 patients were within the optimal operation age scope（TGA/IVS ≤2 weeks , TGA/VSD,TBA≤6 months）, 142 patients missed the the optimal operation age （TGA/IVS 〉 2 weeks, TGA/VSD, TBA 〉 6 months）. Operation approaches： ASO procedure was performed in all the TGA/IVS patients, among them the left ventricular training procedure was performed in an earlier stage in 18 patients whose ages were 〉 2 weeks. VSD repair ＋ ASO procednres were performed in all the TGA/VSD,TBA patients including 4 patinents who had received pulmonary banding previously. Results 26 patients died after ASO, the overall mortality rate was 9.85%. Follow up [ （29.5 ± 7.6）months] showed 2 patients who were 〉 6 months＇ TGA/VSD died 2 months and 1.5 years respectively after surgery, 1 patient received re-do operation for the pulmonary anastomotie stoma stenosis 1.5 years after ASO, all other survivals have no complications and death, cyanesis was significantly reduced,physical activities increased obviously. The mortality rate of patients who were within the optimal operation age scope was 13.11%, while the mortality rate of patients who had missed the optimal operation age seope was 7.04 %. The overall mortality rate decreased from 19.09 % to 3.25 % （ P 〈 0.05） after Janaury 2006. In the mean while, for patients who were within the optimal operation age scope ,the mortality rate decreased from 22.64% to 5.80%（ P 〈0.05）; for patients who had missed the optimal operation age ,the mortality rate decreased signifieantly from 15.79% to 1.18% （P 〈 0.05）. Conclusion Satisfactory result still can be acquired in patients who had missed the optimal surgery age.