两种术式矫治法洛四联症术后肺动脉和左心室发育的对比研究

Comparative study on the growth of pulmonary artery and left ventricle between two kinds of surgical repair for tetralogy of Fallot

目的对比保留瓣环与跨瓣环补片矫治法洛四联症(TOF)术后肺动脉和左心室发育速度。方法回顾本院2015年1月至2020年10月收治的TOF患婴临床资料,根据右心室流出道狭窄的解除方式分为:保留瓣环组和跨瓣环组。采用独立样本t检验或非参数检验比较两组间术前、末次随访时肺动脉和左心室发育指标,术前与术后指标的比较采用配对t检验。结果共纳入TOF患婴104例,其中男58例,女46例;中位年龄6.7(4.1,10.3)个月,中位体质量7.0(5.8,8.4)kg。术前保留瓣环组Nakata指数、McGoon比值、肺动脉Z值、左心室舒张末期容积(LVEDV)指数及其Z值均大于跨瓣环组(P=0.001,0.000,0.003,0.000,0.000)。末次随访时,两组肺动脉Z值均大于术前(P=0.016,0.000),跨瓣环组LVEDV Z值大于术前(P=0.000),而保留瓣环组LVEDV Z值与术前相比无明显差异(P=0.581),肺动脉Z值和LVEDV Z值两组间比较无显著差异(P=0.468,0.884)。保留瓣环组肺动脉Z值、LVEDV Z值末次随访与术前的差值均小于跨瓣环组(P=0.000,0.000)。结论与保留瓣环相比,跨瓣环补片矫治TOF术后早期肺动脉和左心室的发育速度较快。

Objective To compare the growth speed of pulmonary artery and left ventricle after the repair of tetralogy of Fallot(TOF)with valve-sparing and transannular patch.Methods The clinical data of children with tetralogy of Fallot admitted to our hospital from January 2015 to October 2020 were reviewed.According to the way of relieving right ventricular outflow tract stenosis,they were divided into two groups:valve-sparing and transannular patch.Independent sample t test or non-parametric test was used to compare the pulmonary artery and left ventricular growth indexes before operation and at the last follow-up between the two groups.The paired t test was used to compare preoperative and postoperative indexes.Results A total of 104 children with tetralogy of Fallot,including 58 males and 46 females,had surgery at a median age and weight of 6.7(4.1,10.3)months and 7.0(5.8,8.4)kg,respectively.The preoperative Nakata index,McGoon ratio,pulmonary artery Z-score,left ventricular end diastolic volume(LVEDV)index and Z-score in valve-sparing were higher than those in transannular patch(P=0.001,0.000,0.003,0.000,0.000).At the last follow-up,the Z-scores of pulmonary arteries in both groups were greater than those before operation(P=0.016,0.000),the LVEDV Z-score in transannular patch was greater than that before surgery(P=0.000),while the LVEDV Z-score of valve-sparing was not significantly different from that before operation(P=0.581),there was no significant difference in pulmonary artery Z-score and LVEDV Z-score between two groups(P=0.468,0.884).The difference between the last follow-up and preoperative of pulmonary artery Z-score and LVEDV Z-score in valve-sparing was smaller than that in transannular patch(P=0.000,0.000).Conclusion Compared with valve-sparing,the pulmonary artery and left ventricle grow faster in transannular patch during the early stage after TOF repair.