摘要
目的总结无内膜接触缝合(Sutureless)技术应用于矫治心上型完全性肺静脉异位引流(TAPVC)的临床疗效。方法 2007年7月至2013年12月在广东省心血管病研究所行外科矫治术的所有心上型TAPVC婴幼儿共132例,排除合并单心室、心房异构等患儿,均行双心室根治性手术。全部患儿均行超声心动图检查,绝大部分患儿行CT检查了解肺静脉发育情况,进行术前评估,并术中探查确诊。按不同的手术方式分为传统手术组和Sutureless手术组。其中传统手术组69例,男54例(78.3%)、女15例(21.7%);中位年龄60(30,225)d;中位体重4.85(3.50,6.35)kg。Sutureless手术组63例,男48例(76.2%)、女15例(23.8%),中位年龄90(30,210)d;中位体重4.58(3.72,6.20)kg。随访至2014年1月1日。结果 Sutureless手术组住院死亡率(4.8%vs.7.2%,χ2=1.414,P=0.720)、术后总死亡率(4.8%vs.13.0%,χ2=2.733,P=0.098)均低于传统手术组,但差异无统计学意义。Sutureless手术组术后梗阻率低于传统手术组(1.6%vs.10.1%,χ2=4.236,P=0.040),差异有统计学意义。COX多因素分析发现,传统手术方式、术前肺静脉梗阻与术后肺静脉梗阻的发生显著相关(P=0.023,P=0.016)。传统手术方式与术后死亡无明显相关性(P=0.060)。结论对于心上型TAPVC,Sutureless技术可明显降低术后肺静脉梗阻发生率。
Objective To analyze clinical outcomes of sutureless technique for patients undergoing surgical correc- tion of total anomalous pulmonary venous connection （TAPVC）. Methods Between July 2007 and December 2013, 132 consecutive TAPVC patients underwent surgical correction in Guangdong Cardiovascular Institute. Those patients with such associated congenital cardiac anomalies as single ventricle and right atrial isomerism were excluded from this study. All the patients underwent biventricular repair. Preoperatively, all the patients received echocardiography, and most pa- tients received CT scan to know the development of pulmonary veins. Preoperative diagnosis was confirmed by intraopera- tive exploration. According to different surgical techniques, all the patients were divided to a conventional technique group and a sutureless technique group. In the conventional technique group, there were 69 patients including 54 males （78.3%） and 15 females （21.7%） with their median age of 60 （30,225） days and median body weight of 4.85 （3.50, 6.35） kg. In the sutureless technique group, there were 63 patients including 48 males （76.20%）and 15 females （23.8%）with their median age of 90 （30, 210） days and median body weight of 4.58 （3.72, 6.20）kg. Follow-up was performed till January 1,2014. Results In-hospital mortality （4.8% vs. 7.2%, x^2=1.414, P=0.720） and postoperative overall mortality （4.8% vs. 13.0%, x^2=2.733, P=0.098） of the sutureless technique group were both lower than those of the conventional technique group, although there was no statistical difference. Postoperative incidence of pulmonary venous obstruction （PVO）of the sutureless technique group was significantly lower than that of the conventional technique group （1.6% vs. 10.1%,x^2=4.236, P=0.040）. COX proportional-hazards regression showed that conventional technique and preoperative PVO were significant risk factors for postoperative PVO （P=-0.023, P=0.016）. Conventional technique was not significantly correlated with postoperative mortality （P=0.060）. Conclusion Sutureless technique can significantly lower postoperative inci- dence of PVO for patients with supracardiac TAPVC.
出处
《中国胸心血管外科临床杂志》
CAS
2014年第6期774-778,共5页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
基金
"十二五"国家科技支撑计划项目(2012BAI04B00)
国家重点基础研究发展计划(973计划)项目(2010CB529500)
广东省医学科研基金指令性课题项目(C2012012)~~
