改良Fontan手术治疗功能单心室合并左异构的早中期临床结果

The Early and Mid-term Outcomes of Modified Fontan Operation in Patients With Functional Single Ventricle and Left Isomerism

目的:总结分析改良Fontan手术治疗功能单心室合并左异构的早期及中期临床结果。方法:回顾性纳入中国医学科学院阜外医院自2009年1月至2016年1月完成的改良Fontan手术治疗功能单心室合并左异构患者19例,依据是否分期完成改良Fontan手术,分为一期手术组(n=9)和分期手术组(n=10),对比分析两组患者术后早期及中期的临床结果。结果:19例患者中,男性13例(68.4%),女性6例(31.6%)。分期手术组患者行第一期Glenn手术时的平均年龄为(1.87±1.56)岁;两组患儿行Fontan手术时的平均年龄为(5.09±2.01)岁。住院期间死亡1例,为分期手术组患者;平均随访时间4.2(1~9)年,随访期间无死亡患者。两组患者术前在性别、年龄、身高、体重、心室形态、房室瓣反流及上腔静脉形态、肺动脉发育和平均肺动脉压力等方面的差异均无统计学意义(P均>0.05);术中体外循环时间、阻断时间、管道建立方式及术后住院时间的组间差异也均无统计学意义(P均>0.05)。在重症监护病房停留时间、机械辅助通气时间及术后血浆用量、胸腔引流量、胸腔引流时间、腹腔积液发生率等方面,一期手术组均优于分期手术组,差异均有统计学意义(P均<0.05)。两组患者术后均出现进行性血氧饱度下降,各有1例患者经皮血氧饱和度<85%,组间差异无统计学意义(P>0.05)。结论:与分期Fontan手术相比,一期Fontan手术治疗年龄偏大的功能单心室合并左异构患者具有良好的围术期结果,两种手术策略在早期和中期疗效方面无明显差异,术后均会出现氧饱和度进行性下降的问题,需要远期随访。

Objectives:To summarize and analyze the early-and med-term outcomes of patients with functional single ventricle and left isomerism undergoing modified Fontan operation.Methods:This retrospective study analyzed clinical data of patients diagnosed with functional single ventricle and left isomerism and underwent modified Fontan operation in Fuwai Hospital from 2009 January to 2016 January.According to whether the modified Fontan operation was completed by stages,the patients were divided into single stage operation group(n=9)and twostage operation group(n=10).The clinical results were analyzed in the early stage and the middle stage after operation.Results:Among the 19 patients,13(68.4%)were male and 6(31.6%)were female.The age of the first Glenn operation in the staged Fontan operation group was(1.87±1.56)years.When Fontan operation was completed,the average age was(5.09±2.01)years.One patient in two-stage operation group died early post operation,total mortality rate was 5.3%.The average follow-up time was 4.2(1-9)years,and no death occurred during the follow-up period.General clinical data including gender,age,body weight,ventricular morphology,atrioventricular valve regurgitation,morphology of superior vena cava pulmonary artery development and mean pressure were similar between the two groups(all P>0.05).There were no significant differences in cardiopulmonary bypass time,aorta clamping time,postoperative hospitalization time and pipeline connection mode between the two groups(all P>0.05).There were significant differences in mechanical ventilation time,intensive care time,plasma dosage,thoracic drainage time and incidence of peritoneal effusion between the two groups(all P<0.05),the perioperative results of single stage operation group were significantly better than those of two-stage operation group.Both groups showed progressive oxygen saturation decrease after operation,and one patient in each group experienced a percutaneous oxygen saturation of less than 85%.Oxygen saturation post operation was similar between the two groups(P>0.05).Conclusions:Perioperative results are better in single stage Fontan operation group than in two-stage Fontan operation group for older patients with functional single ventricle and left isomerism.There is no significant difference in the curative effect between the two groups in the early and middle stages,but progressive oxygen saturation decrease occurred in both groups,the impact of this phenomenon deserves long-term follow-up.