大动脉转位的外科治疗:单中心的临床治疗经验

Surgical treatment of transposition of the great arteries:clinical experience in single center

目的总结本院TGA患者的外科治疗经验。方法回顾2017年9月-2022年7月在云南省阜外心血管病医院接受外科治疗的10例TGA患者,收集术前临床资料,包括性别、年龄、体重、合并心脏畸形、体循环心室射血分数;术中术后临床资料,包括术式、体外循环时间、主动脉阻断时间、手术时间、ICU带管时间、术后ICU停留时间、住院时间、再次手术干预;记录住院死亡率、早期死亡率(术后30 d内死亡)、手术并发症等情况,术后进行常规随访。结果共收治TGA患者10例,其中D-TGA 4例,均为儿童,均接受了ASO。CC-TGA6例,其中3例为儿童,1例接受了肺动脉环缩术、1例接受了双向Glenn手术、1例接受了肺动脉环缩术+双向Glenn手术;另外3例为成人,均接受了三尖瓣机械瓣置换。所有患者无住院死亡与早期死亡,2例患者接受了再次手术干预,其后顺利出院。出院随访尚未发现手术相关并发症。结论ASO是D-TGA患者的外科治疗标准术式,但手术时机仍存在争议,术后远期生存率与并发症的相关研究还需进一步探索。对于CC-TGA患者,多根据各个医疗中心临床经验制定个体化治疗方案,外科治疗策略的确定充满挑战。

Objective To summarize the surgical treatment experience of transposition of the great arteries(TGA)in our hospital.Methods 10 TGA patients who underwent surgical treatment in Yunnan Fuwai Cardiovascular Hospital from September 2017to July 2022 were retrospectively reviewed.It collected preoperative clinical data including gender,age,weight,associated cardiac anomalies,systemic circulation ventricular ejection fraction;intraoperative and postoperative clinical data including operation type,cardiopulmonary bypass time,aortic occlusion time,operation time,tracheal intubation time in ICU,postoperative ICU stay time,length of hospital stay,reoperation intervention;It recorded hospitalization mortality,early mortality(death within 30 days after operation),and surgical complications.Routine follow-up was performed after operation.Results A total of 10 TGA patients were included.Among them,4 infants were diagnosed as dextrotransposition of the great arteries(D-TGA)and received arterial switch operation(ASO).6 patients were diagnosed as congenitally corrected TGA(CC-TGA).3 cases were children,1 case received pulmonary artery banding,1 case received bidirectional Glenn procedure,and 1 received pulmonary artery banding and bidirectional Glenn procedure;The other three patients were adults and received tricuspid valve replacement.There was no hospitalization and early death in all patients.Reoperation were performed in 2 patients,and discharged from the hospital.There was no complications till now in the follow-up.Conclusions ASO is the standard surgical treatment for D-TGA,but the timing of the operation remains controversial.It needs further explore the relevant research on postoperative long-term survival rate and complications.As for CC-TGA patient,the individualized surgical approach is depended on clinical experiences of medical center.Defining surgical strategies can be challenging.