非体外循环与体外循环下肺动脉瓣切开术治疗室间隔完整型肺动脉闭锁的疗效对比研究

Comparative study of off-pump and on-pump pulmonary valvulotomy in the treatment of pulmonary atresia with intact ventricular septum

目的通过评价非体外循环和体外循环下肺动脉瓣切开术作为初期手术治疗室间隔完整型肺动脉闭锁(PA/IVS)的临床状况,比较两种方法的手术疗效和早中期预后效果。方法回顾2015年1月至2020年12月,共45例PA/IVS患儿在我院接受非体外循环或体外循环下肺动脉瓣切开术,分为非体外循环组(28例)和体外循环组(17例),对两组患儿术后病死率、手术时间、术后早期以及中期随访情况等予以分析。结果两组共4例死亡,死亡率8.9%(4/45)。非体外循环组1例死亡,体外循环组3例死亡,两组死亡率差异无统计学意义(3.6%比17.6%,P=0.108),但在手术时间[(52.3±16.8)min比(107.6±22.7)min]、血管活性药物维持时间[(122±24.8)h比(218±32.5)h]、气管插管时间[(57.3±25.4)h比(92.5±23.6)h]、ICU滞留时间[(4.5±2.3)d比(7.6±2.6)d]、住院时间[(8.5±3.2)d比(14.3±5.7)d]等方面均具有显著差异(P<0.01)。中期随访共失访3例,非体外循环组有12例无需再手术,10例已完成终期手术;体外循环组有5例无需手术,6例患儿完成终期手术。两组纽约心功能分级(NYHA)均在Ⅰ~Ⅱ级。结论与体外循环相比,非体外循环下肺动脉瓣切开术具有操作简便、手术时间短、手术成功率高及术后恢复快等早期疗效优势。

Objective To evaluate the clinical effects of off-pump and on-pump pulmonary valvulotomy for the patients with pulmonary atresia with intact ventricular septum(PA/IVS).Methods From January 2015 to December 2020,cases of 45 PA/IVS children who underwent off-pump or on-pump pulmonary valvulotomy in our hospital were retrospectively reviewed,including off-pump group(28 cases)and on-pump group(17 cases).The postoperative mortality,operation time,early and mid-term follow-up of the two groups were analyzed.Results There were 4 deaths in the 2 groups and the mortality rate was 8.9%(4/45).There were 3 deaths in the on-pump group,and 1 death in the off-pump group.The mortality rate between the two groups were not significantly different(3.6%vs.17.6%,P=0.108).However,there were significant differences(P<0.01)in operation time[(52.3±16.8)min vs.(107.6±22.7)min],maintenance time of vasoactive drug[(122±24.8)h vs.(218±32.5)h],intubation time[(57.3±25.4)h vs.(92.5±23.6)h],ICU stay time[(4.5±2.3)d vs.(7.6±2.6)d]and postoperative hospital time[(8.5±3.2)d vs.(14.3±5.7)d]between the two groups.During the mid-term follow-up,there were 3 cases lost.During the follow-up period,in the off-pump group,12 cases did not need further operation,and 10 cases completed the final operation.In the on-pump group,5 cases did not need further operation,and 6 cases completed the final operation.Heart function classification of all patients was in New York Heart Association classⅠ-Ⅱ.Conclusion The off-pump pulmonary valvulotomy might be potentially more popular in clinical practice,owing to its advantages in simpler operation techniques,shorter operation time,higher success rate and quicker postoperative recovery.