Mascio Christopher E, Wayment Matthew, Colaizy Tarah T, Mahoney Larry T, Burkhart Harold M
Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Louisville, 201 Abraham Flexner Way, Suite 1200, Louisville, KY 40202, USA.
Am Surg. 2009 Feb;75(2):175-7. doi: 10.1177/000313480907500213.
The modified Fontan procedure may be complicated by prolonged pleural drainage. Predisposing factors are not fully understood. This study examines perioperative variables associated with prolonged effusions. We examined the Fontan procedure in 41 patients. Mean age was 45 months (range, 9 to 113 months). Mean weight was 14.7 kg (range, 6.9 to 30.4 kg). Diagnoses included tricuspid atresia in 29 per cent, pulmonary atresia in 12 per cent, and double-outlet right ventricle in 12 per cent. Fontan revisions were excluded. The extracardiac Fontan was performed in 22 patients (54%) and the lateral tunnel (LT) in 18 (44%). Fenestration was performed in 56 per cent. Ten patients (24%) had prolonged pleural effusions. Mean chest tube output (24.2 vs 14.1 mL/kg/d, P < 0.01), days with chest tubes (10.2 vs 5.8 days, P < 0.01), and length of stay (20.8 vs 8.13 days, P < 0.01) were significantly greater in those with effusions. Preoperative mean pulmonary artery pressure was higher in patients with prolonged effusions (12.7 vs 9.90 mmHg, P = 0.001). No other factors were identified as risk factors. Prolonged pleural effusions (greater than 14 days) are common after the modified Fontan procedure. A higher preoperative mean pulmonary artery pressure may be predictive of these effusions. Fenestration, type of Fontan reconstruction, and size of extracardiac conduit did not predispose to postoperative effusions.
改良Fontan手术可能会因胸腔引流时间延长而变得复杂。其诱发因素尚未完全明确。本研究探讨了与胸腔积液持续时间延长相关的围手术期变量。我们对41例患者进行了Fontan手术。平均年龄为45个月（范围9至113个月）。平均体重为14.7千克（范围6.9至30.4千克）。诊断包括29%为三尖瓣闭锁，12%为肺动脉闭锁，12%为右心室双出口。排除Fontan翻修手术。22例患者（54%）进行了心外Fontan手术，18例（44%）进行了侧隧道（LT）手术。56%进行了开窗术。10例患者（24%）出现了胸腔积液持续时间延长。有胸腔积液患者的平均胸管引流量（24.2 vs 14.1 mL/kg/d，P<0.01）、留置胸管天数（10.2 vs 5.8天，P<0.01）和住院时间（20.8 vs 8.13天，P<0.01）显著更长。胸腔积液持续时间延长患者的术前平均肺动脉压更高（12.7 vs 9.90 mmHg，P = 0.001）。未发现其他因素为危险因素。改良Fontan手术后胸腔积液持续时间延长（超过14天）很常见。较高的术前平均肺动脉压可能是这些胸腔积液的预测指标。开窗术、Fontan重建类型和心外管道大小不会诱发术后胸腔积液。
