右室双出口解剖条件影响矫治手术选择和生存的危险因素分析

Analysis of the anatomy as risk factor on choice of corrective strategies and subsequent outcomes in double outlet right ventricles

目的 通过分析右室双出口的解剖特点、手术选择和结果 ,以筛选解剖条件中内在的相关规律及与矫治手术死亡相关的危险因素。方法 10 9例右室双出口病儿 ,根据不同的室间隔缺损 (VSD)位置、大血管位置和并发畸形等解剖特点分类 ,VSD位置分别与大血管位置和手术方法选择进行相关性检验 ,Logistic逐步回归筛选与住院死亡相关的危险因素 ,并建立术前预测死亡概率的模型。 结果 主、肺动脉位置为侧侧位或主动脉右前斜位 ,VSD大多为主动脉下 ,手术方法以心室内矫治 (IVR)为主 ;大血管位置为前后位 ,VSD大多为肺动脉瓣下 ,手术方法以Rastelli和大动脉转位术 (ASO)为主。主动脉右前斜位、主动脉瓣下VSD的相对危险度小于 1,主动脉左前斜位、VSD远离大动脉开口及左室发育不良等解剖条件的相对危险度大于 1,Logistic回归方程组内考核的符合率为 80 7%。 结论 VSD位置和大血管位置及手术方法选择之间有显著的相关性 ,主动脉右前斜位、左前斜位、主动脉下VSD或VSD远离大动脉开口及左室发育不良等解剖条件对住院死亡有显著影响。

Objective: To analyze the correlation between anatomy and choice of corrective strategies and subsequent outcomes in double outlet right ventricles. Methods: 109 cases were classified according to anatomy, corrective strategies, and by stepwise logistic regression, preoperative risk of death prediction was evaluated. Results: Subaortic VSD, usually correlated with parallel Ao, PA or right anterior oblique Ao, and were corrected with intraventricular repair (IVR) subpulmonary VSD, usually related to anterior. Posterior Ao, were corrected with Rastelli or arterial switch (ASO). The relative risk of death was less than 1 in group I, while it was greater than 1 in patients with non-committed VSD and hypoplastic left ventricle. The accuracy of logistic prediction was around 80%. Conclusion: There is significant correlation between anatomy and surgical strategies. Position of aortic ventricular septal defect and development of left ventricle significantly influence the surgical outcomes.