新生儿完全性肺静脉异位连接手术治疗结果

Surgical repair for simple total anomalous pulmonary venous connection in neonates

目的分析预测新生儿完全性肺静脉异位连接(total anomalous pulmonary venous connection,TAPVC)矫治术预后相关危险因素。方法回顾性分析2009年1月至2018年1月收治的105例接受TAPVC手术治疗的新生儿。心上型42例(40%,42/105)、心内型21例(20%,21/105)、心下型36例(34.3%,36/105)和混合型6例(5.7%,6/105)。采用Cox比例风险分析方法分析术后肺静脉梗阻(pulmonary venous obstruction,PVO)及病死率的相关危险因素。Kaplan-Meier用于分析总生存率。结果26例(24.8%,26/105)患儿诊断为梗阻性TAPVC。术后30天、1年和5年生存率分别为92.4%、86.7%和86.7%。术后PVO共17例(16.2%,17/105)。术前酸中毒、手术时低体质量、体外循环时间延长、术后中心静脉压升高(central venous pressure,CVP)、再手术为术后死亡的相关危险因素,其中术前酸中毒(P<0.001)、体外循环时间延长(P<0.001)和术后CVP升高(P=0.005)为术后死亡的独立危险因素。混合型TAPVC、术前酸中毒、手术年龄小、体外循环时间延长、术后肺动脉高压为术后PVO的相关危险因素,其中体外循环时间延长(P=0.029)、术后肺动脉高压(P<0.001)和混合型TAPVC(P=0.017)是与术后PVO相关的独立危险因素。结论我中心近5年新生儿TAPVC的术后死亡比例和PVO发生率较低,术前酸中毒、体外循环时间延长和术后CVP升高的新生儿预后较差。混合型TAPVC患儿术后发生PVO的风险更高。

Objective This study aimed at analyzing risk factors associated with surgical outcomes of neonatal total anomalous pulmonary venous connection(TAPVC)in our center.Methods A total of 105 neonates who underwent surgical repair for TAPVC from January 1st,2009 to January 1st,2018 were retrospectively analyzed.The anatomical types of TAPVC included supracardiac 42(40%,42/105),cardiac 21(20%,21/105),infracardiac 36(34.3%,36/105),and mixed 6(5.7%,6/105).The Cox proportional hazards analysis was used to analyze the risk factors related to postoperative pulmonary venous obstruction(PVO)and mortality.Kaplan-Meier analysis was used to analyze the overall survival rates.Results Twenty-six patients(24.8%,26/105)were diagnosed with preoperative PVO.The 30-day,1 year,and 5 years survival rate was 92.4%,86.7%,and 86.7%respectively.Postoperative PVO occurred in 17 patients(16.2%,17/105).Preoperative acidosis,low surgical weight,prolonged duration of cardiopulmonary bypass time,increasing postoperative central venous pressure(CVP),and reoperation were risk factors associated with mortality.Preoperative acidosis(P<0.001),prolonged duration of cardiopulmonary bypass time(P<0.001),and increasing postoperative CVP(P=0.005)were independent risk factors for mortality.Mixed TAPVC,preoperative acidosis,low surgical age,prolonged cardiopulmonary bypass time,postoperative pulmonary arterial hypertension were risk factors associated with postoperative PVO.Prolonged cardiopulmonary bypass time(P=0.029),postoperative pulmonary arterial hypertension(P<0.001),and mixed TAPVC(P=0.017)were independent risk factors associated with postoperative PVO.Conclusion The surgical outcomes of neonatal TAPVC in our center were acceptable,with low mortality rate and incidence of PVO.However,neonates with preoperative acidosis,prolonged duration of cardiopulmonary bypass time,and increased postoperative CVP had a poor prognosis.Patients with mixed TAPVC were at increased risk for postoperative PVO.