大动脉调转术手术时机对完全性大动脉转位患儿预后的影响

目的 评价大动脉调转术(ASO)手术时机对完全性大动脉转位患儿预后的影响.方法 2008年1月-2009年12月共64例完全性大动脉转位(TGA)患儿在本院行一期ASO,其中36例室间隔完整(IVS),28例并室间隔缺损(VSD).各组依手术时年龄分为IVS/early组(≤14 d)和IVS/late组(＞14 d),VSD/early组(≤28 d)和VSD/late组(＞28 d).回顾性分析各亚组术后围术期并发症及存活情况;随访出院患儿了解其存活情况.结果 各亚组患儿在围术期肺动脉狭窄、低心排出量综合征、吻合口出血、创口愈合不良、膈肌麻痹、呼吸道异常、心律失常及呼吸道感染等并发症发生率比较差异均无统计学意义.3例患儿院内死亡,TGA/IVS组及TGA/IVS组2个亚组院内病死率比较差异无统计学意义(TGA/IVS组:8.3% vs 0,TGA/VSD组:0 vs 7.7%,Pa＞0.05).随访13个月,2例患儿院外死亡,TGA/IVS组及TGA/IVS组中2亚组间早期病死率比较差异均无统计学意义(TGA/IVS组:10.5% vs 10.0%,TGA/VSD组:0 vs 22.2%,Pa＞0.05).结论 手术年龄不应是影响TGA患儿预后的主要原因,术前机体状态、早产、感染、遵嘱随访是影响TGA患儿预后的重要因素,术前改善机体状态、术后加强随访有助于改善TGA患儿预后,提高其生存率.

Effect of Surgical Time on Outcomes Following Primary Arterial Switch Operation in Children with Transposition of Great Arteries

Objective To investigate the effect of surgical time on outcomes following primary ASO in children with transposition of great arteries(TGA).Methods Sixty-four infantile patients diagnosed as TGA had primary ASO from Jan.2008 to Dec.2009.They were divided into 2 groups,36 with intact ventricular septum(IVS)and 28 with ventricular septal defect(VSD).Each group was further divided into 2 subgroups(early group and late group)with a boundary of surgical age of 14 days and 28 days separately.The perioperative complications and mortality of 2 subgroups in each group and follow up of the discharged patients were analyzed retrospectively.Results There were no significant differences between the 2 subgroups in each group in postoperative complications such as pulmonary stenosis,low cardiac output syndrome,bleeding of the incision,faulty union of the incision,diaphragmatic paralysis,airway abnormalities,arrhythmia and pulmonary infection.Three cases occurred hospital deaths and there was no significant difference of the hospital mortality between 2 subgroups in TGA/IVS group(8.3% vs 0,P>0.05)and TGA/VSD group(0 vs 7.7%,P>0.05).With a median follow-up of 13 months,2 cases of late deaths occured and there was no statistical difference of early mortalities between the 2 subgroups in TGA/IVS group(10.5% vs 10.0%,P>0.05) and TGA/VSD group(0 vs 22.2%,P>0.05).Conclusions Preoperative conditions,preterm,infection and follow-up in time rather than age are important factors affecting postoperative outcomes of patients with primary ASO.Improving preoperative conditions and intensifying follow-up will improve postoperative outcomes.