超适龄完全房室间隔缺损外科治疗的临床分析

Surgical treatment for complete atrioventricular septal defect in patients above the optimal age

目的总结超过手术建议年龄的完全房室间隔缺损(complete atrioventricular septal defect,CAVSD)患儿外科治疗的效果及经验。方法回顾性分析2002~2013年163例7周岁以下单纯CAVSD患儿的临床资料,根据是否>1周岁分为适龄组[n=84,其中男37例、女46例,平均年龄(7.6±2.7)个月]与超龄组[n=79,其中男30例、女49例,平均年龄(34.6±19.6)个月]。结果两组患者在平均主动脉阻断时间[(88.3±24.4)min vs.(106.1±35.4)min,P<0.001]、平均体外循环时间[(123.6±31.1)min vs.(142.6±47.1)min,P=0.003]方面差异有统计学意义。术后随访过程中[适龄组(53.3±43.9)个月,超龄组(57.2±48.2)个月],两组在全因死亡率(10.7%vs.8.9%,P=0.691)、中重度左侧房室瓣反流发生率(16.7%vs. 21.5%,P=0.430)及再干预率(3.6%vs. 0.0%,P=0.266)方面差异无统计学意义。两组均无左室流出道梗阻及房室传导阻滞发生。结论经过合理的外科治疗,超过建议矫治年龄的患儿也可取得令人满意的结果。

Objective To summarize the clinical outcomes and experience of surgical treatment for patients with complete atrioventricular septal defect(CAVSD)above the optimal age for surgery.Methods We retrospectively reviewed clinical data of 163 simple type CAVSD patients less than 7 years who underwent operations in Fuwai Hospital from 2002 to 2013.The patients were divided into a normal group(n=84,including 37 males and 16 females with an average age of 7.6±2.7 months)and an over-age group(n=79,including 30 males and 49 females with an average age of34.6±19.6 months)according to whether the age was more than 1 year.Results The average aortic cross clamp time(88.3±24.4 min vs.106.1±35.4 min,P<0.001)and cardiopulmonary bypass time(123.6±31.1 min vs.142.6±47.1 min,P=0.003)were statistically different between the two groups.During the follow-up period(the normal group 53.3±43.9 months,the over-age group 57.2±48.2 months),there was no statistical difference in all-cause mortality(10.7%vs.8.9%,P=0.691),the incidence of moderate or severe left atrioventricular valve regurgitation(16.7%vs.21.5%,P=0.430)and reintervention rate(3.6%vs.0.0%,P=0.266)between the two groups.No left ventricular outflow tract obstruction and complete atrioventricular block occurred in both groups.Conclusion For CAVSD children above the optimal age,rational surgical treatments can also achieve satisfying results.