常规手术和sutureless法手术纠治心上型完全性肺静脉异位引流

Conventional and sutureless techniques for surgical repair of supracardiac total anomalous pulmonary venous connection

目的评价常规手术和sutureless法手术纠治心上型完全性肺静脉异位引流的疗效。方法回顾性分析2004年1月至2016年1月150例行常规手术或sutureless法手术纠治心上型完全性肺静脉异位引流患儿的临床资料。男94例,女56例;首次手术时患儿中位年龄70天(1~6493天),中位体质量4.6 kg(1.8~37.0 kg)。中位随访时间23个月(0~102个月)。采用Kaplan-Meier曲线进行生存评估,Cox风险模型分析死亡和术后肺静脉梗阻的危险因素。结果早期死亡9例,晚期死亡2例。术后30天、1年和12年的生存率分别为94.0%、93.3%和92.7%。141例出院患儿中135例(95.7%,135/141)完成随访。中位随访时间47个月(0~136个月)。21例因术后肺静脉梗阻需要再次手术。新生儿组死亡比例较婴幼儿组和儿童组高,差异有统计学意义(P=0.026)。对于术前诊断为肺静脉梗阻的患儿,选择sutureless手术组和常规手术组总体生存率差异无统计学意义(P=0.741)。与常规手术组相比,sutureless手术组免于再手术的风险差异无统计学意义(常规手术组55.6%对sutureless组90.9%,P=0.166)。Cox回归模型分析,术前肺静脉梗阻(P=0.015)、呼吸机时间延长(P=0.011)是死亡的危险因素。体外循环时间(P=0.038)是再次手术干预的危险因素。结论常规手术或sutureless法纠治心上型完全性肺静脉异位引流均可取得满意疗效。

Objective To review our experiences with conventional and sutureless techniques in patients with supracardiac total anomalous pulmonary venous connection.Methods From January 2004 to January 2016,150 patients with suparacardiac total anomalous pulmonary venous connection underwent conventional or sutureless techniques.Kaplan-Meier curve was used to demonstrate the survival estimates.Cox proportional hazard model was used to identify risk factors for death and postoperative pulmonary venous obstruction(PVO).Results There were 9 in-hospital deaths and 2 late deaths.The survival rates at 30 days,1 year,and 12 years were 94.0%,93.3%,and 92.7%,respectively.Follow-up was completed in 95.7%of the survivors.Median follow-up was 47 months(range:0-136 months).Twenty-one patients required reoperation for pulmonary venous obstruction.The survival rates in neonate group is significantly lower than that in infants and children group(P=0.026).For those who were diagnosed with preoperative PVO,the survival rates(conventional group 92.3%VS sutureless group 93.9%,P=0.741)and incidence of freedom from reoperation(conventional group 55.6%VS sutureless group 90.9%,P=0.166)in both the conventional and sutureless group were similar.Multivariable analysis showed that preoperative pulmonary venous obstruction(P=0.015)and longer duration of ventilation(P=0.011)were incremental risk factors for death.Aortic cross-clamp time(P=0.038)was associated with postoperative pulmonary venous obstruction.Conclusion Both the conventional and sutureless techniques in surgical repair for supracardiac total anomalous pulmonary venous connection can achieve satisfactory outcomes.