室间隔缺损类型对法洛四联症患儿手术结果的影响。

Influence of ventricular septal defect type on surgical results in children with tetralogy of Fallot.

作者信息

Fu Y C, Hwang B, Weng Z C, Lu J H, Chi C S, Meng C C

机构信息

Department of Pediatrics, Taichung Veterans General Hospital, Taichung, 201, Section 2, Shih-Pai Road, Taipei 112, Taiwan, ROC.

出版信息

Zhonghua Yi Xue Za Zhi (Taipei). 2000 Nov;63(11):792-7.

PMID:11155754

Abstract

BACKGROUND

Tetralogy of Fallot (TOF) with subpulmonary ventricular septal defects (VSD) is relatively more common among Orientals than among Occidentals. This study assessed the influence of type of VSD on surgical results in children with TOF.

METHODS

Fifty-one patients with TOF (age range, 14 months to 11 years, mean 40.7 months, median 30 months, 29 boys, 22 girls) who underwent total correction by a single surgeon between January 1992 and December 1995 were retrospectively studied. Of the 51 patients, 17 patients with subpulmonary VSD were classified as group I. The remaining 34 patients with perimembranous VSD were classified as group II. All patients underwent a combined transatrial and transpulmonary surgical approach. Early postoperative results were evaluated 7 to 10 days after surgery and late postoperative results were evaluated 1 year after surgery.

RESULTS

There were no statistically significant differences between the two groups in age, sex, body weight, pulmonary to systemic flow ratio, pulmonary to aortic annulus diameter ratio or preceding palliative shunt or balloon pulmonary valvuloplasty. Nevertheless, group I patients had better oxygen saturation preoperatively (84.2 +/- 4.4% vs 80.3 +/- 7.6%, p = 0.037). During surgery, the transannular patch rate was higher in group I (100% vs 73.5%, p = 0.003). The cardiopulmonary bypass time, postoperative stay in the intensive care unit, duration of chest tube placement, early postoperative residual VSD rate, and early and late postoperative residual pulmonary stenosis rate were not significantly different between the groups. However, late postoperative residual VSD rate was 33.3% in group I and 6.45% in group II, which was statistically significant (p = 0.029). There were no significant differences in arrhythmia between the two groups.

CONCLUSIONS

Patients with TOF with subpulmonary VSD had a better preoperative oxygenation, higher transannular patch rate during surgery and a higher incidence of late residual VSD than those with TOF with perimembranous VSD.

摘要

背景

与西方国家人群相比，东方人群中伴有肺动脉瓣下室间隔缺损（VSD）的法洛四联症（TOF）相对更为常见。本研究评估了VSD类型对TOF患儿手术结果的影响。

方法

对1992年1月至1995年12月间由同一外科医生进行根治手术的51例TOF患者（年龄范围14个月至11岁，平均40.7个月，中位数30个月，男29例，女22例）进行回顾性研究。51例患者中，17例伴有肺动脉瓣下VSD的患者被归为I组。其余34例伴有膜周部VSD的患者被归为II组。所有患者均采用经心房和经肺动脉联合手术入路。术后早期结果在术后7至10天进行评估，术后晚期结果在术后1年进行评估。

结果

两组在年龄、性别、体重、肺循环与体循环血流量比值、肺动脉与主动脉环直径比值或先前的姑息性分流术或球囊肺动脉瓣成形术方面无统计学显著差异。然而，I组患者术前氧饱和度更高（84.2±4.4%对80.3±7.6%，p = 0.037）。手术过程中，I组的跨环补片使用率更高（100%对73.5%，p = 0.003）。两组之间的体外循环时间、术后在重症监护病房的停留时间、胸管放置时间、术后早期残余VSD发生率以及术后早期和晚期残余肺动脉狭窄发生率无显著差异。然而，I组术后晚期残余VSD发生率为33.3%，II组为6.45%，具有统计学显著性差异（p = 0.029）。两组在心律失常方面无显著差异。