法洛四联症根治术中采用限制性右心室切口与传统右心室切口的临床结果比较

Outcomes of Anatomical Repair for Tetralogy of Fallot:Role of Limited Right Ventriculotomy

目的对法洛四联症根治术中采用限制性右心室切口(right ventricle,RV)与传统右心室切口的临床结果进行比较。方法选取2019年1月至2021年5月在中国医学科学院阜外医院诊断为TOF且接受保留肺动脉瓣环完整性根治手术治疗的患者组成回顾性队列,依据术中是否采取限制性RV切口,分为限制性RV切口组和传统右室切口组。主要终点事件包括死亡、机械通气时间延长、心包积液和顽固性胸腔积液。结果本研究共纳入TOF患者50例,中位年龄8.1个月(2.3~20.1个月),中位体重8.4 kg(4.9~11.2 kg)。传统RV切口组26例(26/50,52.0%),限制性RV切口组24例(24/50,48.0%)。脱离体外循环后测量右心室与左心室压力比的平均值为(0.58±0.21)。整组患者术后早期及随访期间无一例死亡。限制性RV切口组顽固性胸腔积液(38.4%vs.12.5%,P=0.037)及右室功能不全(26.9%vs.0%,P=0.001)明显减少,两组间其他各围术期主要终点事件结果比较,差异均无统计学意义。两组间死亡(0%vs.0%,P=1.000)、机械通气时间延长(26.9%vs.25.0%,P=0.877)和心包积液(26.9%vs.12.5%,P=0.203)发生率差异均没有统计学意义。结论采取限制性RV切口完成法洛四联症根治术对于肺动脉瓣发育尚可的患者而言,可有效解除右心系统梗阻,一定程度上避免右心功能破坏,围术期及早期手术结果满意。

Objective To compare the clinical results of restrictive right ventricle(RV)and traditional right ventricular incision in radical surgery for tetralogy of Fallot.Methods A retrospective analysis was performed on patients diagnosed of TOF and undergoing radical operation with preserved pulmonary valve from January 2019 to May 2021.The patients were divided into traditional right ventriculotomy(RV)group and limited RV group according to different surgical procedures.Main endpoints included death,prolonged mechanical ventilation,pericardial effusion and refractory pleural effusion.Results 50 cases of TOF were included with a median age of 8.1(2.3-20.1)months and a median weight of 8.4(4.9-11.2)kg.26 patients underwent traditional RV approach while the other 24 underwent limited RV.Mean right:left ventricle pressure ratio after cardiopulmonary bypass was 0.58±0.21.There was no death documented in the early post-operation and during follow-up.Except the limited RV group witnessed obvious decline in refractory pleural effusion(38.4%vs.12.5%,P=0.037)and right ventricle dysfunction(26.9%vs.0%,P=0.001),the main perioperative endpoints have no statistically significant inter-group differences.Conclusion For patients with functional pulmonary valve,the limited right ventriculotomy in TOF repair could remove right ventricular outflow tract obstruction,maintain the right ventricular function and improve surgical outcomes.