改良Sutureless技术治疗完全性肺静脉异位引流

A modified sutureless technique treating total anomalous pulmonary venous connection

目的介绍一种改良Sutureless技术及其治疗完全性肺静脉异位引流的手术效果。方法回顾性分析阜外医院小儿心外科2014—2019年行改良Sutureless技术治疗11例完全性肺静脉异位引流患者的临床资料,其中男4例、女7例,中位手术年龄1.4(0.3,27.0)个月,中位体重4.3(3.5,8.5)kg。心上型6例(54.5%)、心下型5例(45.5%)。术前重度肺动脉高压5例(45.5%),术前肺静脉梗阻3例(27.3%)。并将其手术治疗结果与同期行传统手术方法治疗的10例患儿进行比较。结果中位随访时间12(1~65)个月。随访期间,改良Sutureless组未出现死亡及术后肺静脉梗阻事件,在围术期资料及免除再梗阻等方面均较传统手术组显示出优势,但差异无统计学意义(P>0.05)。改良Sutureless组术后生存优于传统手术组(P=0.049)。结论包括“先部分缝合再切开”及“肺静脉内膜外翻扩大开口”等创新点的改良Sutureless技术,是一种治疗完全性肺静脉异位引流的安全可靠的方法,术后近期效果良好。

Objective To introduce a modified sutureless technique and its surgical results in the treatment of total anomalous pulmonary venous connection(TAPVC).Methods Clinical data of 11 patients with TAPVC who underwent the modified sutureless technique treatment from 2014 to 2019 in our center were retrospectively analyzed,including 4 males and 7 females.The median surgical age was 1.4(0.3,27.0)months.The median weight was 4.3(3.5,8.5)kg.Six(54.5%)patients were of supracardiac subtype,and five(45.5%)patients were of infracardiac subtype.Five(45.5%)patients had preoperative severe pulmonary hypertension,and three(27.3%)patients had preoperative pulmonary vein obstruction.The surgical results were compared with those of 10 patients treated with conventional surgical technique.Results The median follow-up was 12(range,1-65)months.During the follow-up,no death or postoperative pulmonary vein obstruction occurred in the modified sutureless technique group.The perioperative data and relief of re-obstruction were superior in the modified sutureless technique group,but the difference was not statistically significant(P>0.05).The postoperative survival of the the modified sutureless technique group was better than that of the traditional surgery group(P=0.049).Conclusion The modified sutureless technique which includes partial suture and then incising,and eversion of pulmonary vein incision,is a safe and reliable method for the treatment of TAPVC with satisfactory short-term results.