新生儿完全性肺静脉异位引流矫治术中垂直静脉的处理策略

Treatment strategies of vertical vein during correction for total anomalous pulmonary venous connection in newborns

目的比较术中垂直静脉的不同处理策略对完全性肺静脉异位引流(total anomalous pulmonary venous connection,TAPVC)新生儿患者矫治术后效果的影响。方法回顾性分析2008年6月至2018年1月于我院行矫治术的72例TAPVC新生儿患者的临床资料。其中男59例、女13例,平均年龄(9.93±8.13)d。根据不同的垂直静脉处理策略,即不结扎、部分结扎和完全结扎,将患者分为不结扎组(22例)、部分结扎组(23例)和完全结扎组(27例),比较组间死亡率及常见并发症发生率。结果完全结扎组的主动脉阻断时间较长(P=0.001),术中停循环例数较少(P=0.005),术后首次肺静脉流速较快(P=0.029),但是随访末次各组间肺静脉流速差异无统计学意义(P=0.393)。其余围术期指标,包括早期死亡率、肺静脉梗阻率和术后垂直静脉未闭合率等差异无统计学意义(P>0.05)。平均随访时间(4.47±2.63)年,各组随访期死亡率差异无统计学意义(P>0.05)。64例存活患者的心功能分级(NYHA)均为Ⅰ~Ⅱ级。结论合理的垂直静脉处理可能有利于手术后的平稳过渡,保证手术成功。

Objective To compare the effect of different treatment strategies of vertical vein on the postoperative efficacy of total anomalous pulmonary venous connection(TAPVC)in newborns.Methods The clinical data of 72 TAPVC newborns who underwent correction in our hospital from June 2008 to January 2018 were retrospectively analyzed.There were 59 males and 13 females,with an average age of 9.93±8.13 d.According to different vertical vein treatment strategies,the patients were divided into an unligated group(22 patients),a partially ligated group(23 patients)and a completely ligated group(27 patients).The mortality and incidence of common complications among the groups were compared.Results In the completely ligated group,the aortic cross-clamp time was longer(P=0.001),intraoperative circulatory arrest cases were less(P=0.005),and the early velocity of pulmonary vein was faster(P=0.029),but there was no significant difference in the velocity of pulmonary vein for the last follow-up among three groups(P=0.393).There was no significant difference in other perioperative indicators among groups,including the early mortality,the incidence of pulmonary vein obstruction and the non-closure of vertical vein after surgery(P>0.05).The mean follow-up time was 4.47±2.63 years.The follow-up mortality was not significantly different among groups(P>0.05).The cardiac function(NYHA)of all the 64 survived patients was classⅠ-Ⅱ.Conclusion Proper vertical vein treatment strategies may be conducive to a smooth transition after surgery,ensuring the success of surgeries.