室间隔完整型完全性大动脉错位手术治疗分析

摘要

Objective To summarize the clinical experience in surgical management of transposition of the great arteries with intact ventricular septum ( TGA/IVS). Methods One hundred and nineteen patients with TGA/IVS were divided into emergency operation group (n =61} and selected operation group (re =58), and patients were subjected to arterial switch operation ( ASO) ( emergency operation group, n = 58; selected operation group, n = 54, including 14 cases of second stage ASO), systemic-pulmonary shunt and pulmonary artery banding ( emergency operation group, n = 2; selected operation group, n = 14) or Senning operation ( emergency operation group, n = 1; selected operation group, n = 4) . The operation and follow up results were observed and compared between two groups, and univariate Logistic regression analysis was performed to determine the influencing factors for mortality early after operation. Results Twelve patients died in hospital after operation (10. 1 % ) , and the mortality of emergency operation group was higher than that of selected operation group, while there was no significant difference between two groups (14. 8% vs5.2%, P=0.08). Univariate Logistic regression analysis revealed that the risk factors for mortality early after operation were emergency ASO and preoperative left ventricle mass (LV Mass) ≤50 g/m2(P =0. 05, P =0. 00). Eighty-three survivors were followed up for 3 months to 4.5 years, during which no death occurred, and 1 patient underwent reoperation for supravalvular pulmonary stenosis. Conclusion Surgical management of TGA/IVS may yield good results, and application of balloon atrial septostomy and assisted circulation may further decrease the mortality after operation.%目的 总结室间隔完整型完全性大动脉错位(TGA/IVS)的治疗经验.方法 119例TGA/[VS患者分为急诊手术组(n=61)和选择性手术组(n=58),分别行大动脉转位手术(ASO)(急诊手术组58例；选择性手术组54例,其中14例为二期ASO)、体肺分流加肺动脉环缩手术(急诊手术组2例,选择性手术组14例)和心房换位术(急诊手术组1例,选择性手术组4例).观察并比较两组手术情况和随访情况,单因素Logistic回归分析影响术后早期死亡的因素.结果 术后院内死亡12例(10 1％),急诊手术组病死率高于选择性手术组,但差异无统计学意义(14.8％vs5.2％,P=0.08).单因素Logistic回归分析显示,影响术后早期死亡的危险因素为急诊ASO和ASO术前左心室心肌质量(LV Mass)≤50 g/m2(P =0.05,P =0.00).83例患者随访3月～4.5年,随访期内无患者死亡,1例因肺动脉瓣上狭窄再次手术.结论 手术治疗TGA/IVS可获得较好的结果,导管介入球囊房间隔造口和辅助循环等技术可进一步降低手术病死率.