新生儿完全性肺静脉异位引流的矫治及预后相关危险因素分析

Risk Factors and Experiences of Surgery for Total Anomalous Pulmonary Venous Connection in Neonates

目的评价单中心的新生儿完全性肺静脉异位引流(total anomalous pulmonary venous connection,TAPVC)外科矫治情况,评估手术的危险因素。方法纳入2002年9月至2014年3月在我院行TAPVC外科矫治的新生儿患者74例,其中男59例、女15例,中位手术年龄10.5 d。心上型35例(47.3%)、心内型16例(21.6%)、心下型17例(23.0%)、混合型6例(8.1%)。采用Cox多因素分析死亡的危险因素,用Binary logistic回归分析术后吻合口或肺静脉狭窄的危险因素。结果共有18例患儿死亡。不同分型的死亡率:心上型占25.7%(9/35),心内型占18.8%(3/16),心下型占17.6%(3/17),混合型占50.0%(3/6)(P=0.413)。术后早期发生吻合口或肺静脉狭窄13例,心上型占17.1%(6/35),心内型占12.5%(2/16),心下型占17.6%(3/17),混合型占33.3%(2/6)(P=0.700)。术后发生吻合口或肺静脉狭窄21例,10例患儿死亡[47.6%(10/21)vs.15.1%(8/53),P=0.003],差异有统计学意义。手术后死亡的独立影响因素为体重<3 kg(P=0.036)。术后吻合口或肺静脉狭窄的发生与使用Sutureless与否(P=0.010)及机械通气时间相关(P=0.000)。结论 Sutureless技术可有效降低术后吻合口或肺静脉狭窄的几率,术后发生吻合口或肺静脉狭窄的患儿死亡率明显增高,体重<3 kg是术后死亡的独立危险因素,应引起临床医生的高度重视。

Objective To analyze the outcome and risk factors of surgical repair for total anomalous pulmonary venous connection(TAPVC). Methods Between September 2002 and March 2014,74 consecutive neonates undergoing surgical repair of total anomalous pulmonary venous connection in our institute were included in this study. There were 59 males and 15 females at mean age of 10.5 d. There were 35 patients(47.3%) with supracardiac,16 patients(21.6%) with cardiac,17 patients(17.6%) with infracardiac,and 6 patients(8.1%) with mixed. Clinical variables possibly associated with death were examined using Cox proportional hazard model. Variables possibly associated with anastomotic or pulmonary vein stenosis were examined using Binary logistic analysis. Results There were 18 operative deaths. Mortality in patients with different TAPVC type varied. The mortality was 25.7%(9/35) in supracardiac,18.8%(3/16) in cardiac,17.6%(3/17) in infracardiac,and 50.0%(3/6) in mixed(P=0.413). Postoperative anastomotic or pulmonary vein stenosis occurred in 21 patients,10 of them died(47.6%(10/21) vs. 15.1%(8/53),P=0.003). An independent risk factor for mortality was body weight less than 3 kg(P=0.036). Sutureless technique(P=0.010) and ventilation time(P=0.000) were highly related to the postoperative anastomotic or pulmonary vein stenosis. Conclusions Sutureless technique can decrease the incidence of postoperative anastomotic or pulmonary vein stenosis. Moreover,the patients who have postoperative anastomotic or pulmonary vein stenosis have higher mortality. The body weight less than 3 kg is an independent risk factor for mortality.