Yamashita Kizuku, Hoashi Takaya, Kagisaki Koji, Kurosaki Kenichi, Shiraishi Isao, Yagihara Toshikatsu, Ichikawa Hajime
Departments of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka, 565-8565, Japan.
Gen Thorac Cardiovasc Surg. 2014 Jan;62(1):48-52. doi: 10.1007/s11748-013-0300-y. Epub 2013 Aug 6.
The efficacy of a sutureless technique for postoperative pulmonary venous stenosis (PVS) following repair of total anomalous pulmonary venous connection (TAPVC) has been reported, though detailed clinical advantages remain unclear. We retrospectively reviewed our surgical experience, and compared outcomes between conventional procedures and a sutureless technique.
For relief of postoperative PVS after TAPVC repair, five patients underwent a conventional procedure, such as orifice cutback or resection of a proliferated intima, from 1999 to 2004 (Conventional group, 4 males, median 93 days old, 3.6 kg), then seven underwent a sutureless technique (Sutureless group, 5 males, 119 days old, 3.4 kg) from 2005 to 2011. Patients with a functional single ventricle were excluded. There were no significant differences regarding patient characteristics. Follow-up examinations were completed in all patients.
The rate for cumulative survival at 5 years was 60 % in the Conventional group and 71.4 % in the Sutureless group. Re-stenosis after relief of PVS occurred in 100 % (10/10) of patients in the Conventional group and 31.6 % (6/19) of patients in the Sutureless group (p = 0.0088). For bilateral venous stenosis patients, the survival rate was 66.7 % (4/6) in the Sutureless group and 0 % (0/2) in the Conventional group (p = 0.10). Out of three patients who developed whole 4-vein stenosis, only one in the Sutureless group survived.
Although overall survival rate was similar in both groups, the Sutureless technique for postoperative PVS following TAPVC repair successfully rescued more pulmonary veins without re-stenosis than conventional procedures. Further follow-up may demonstrate therapeutic advantages.
虽然已有关于无缝合技术用于完全性肺静脉异位连接（TAPVC）修复术后肺静脉狭窄（PVS）的疗效报道，但详细的临床优势仍不明确。我们回顾性分析了我们的手术经验，并比较了传统手术方法与无缝合技术的治疗效果。
为缓解TAPVC修复术后的PVS，1999年至2004年期间，5例患者接受了传统手术，如开口扩大或增生内膜切除术（传统组，4例男性，中位年龄93天，体重3.6千克）；2005年至2011年期间，7例患者接受了无缝合技术（无缝合组，5例男性，119天，体重3.4千克）。排除功能性单心室患者。两组患者的特征无显著差异。所有患者均完成了随访检查。
传统组5年累计生存率为60%，无缝合组为71.4%。传统组PVS缓解后再狭窄发生率为100%（10/10），无缝合组为31.6%（6/19）（p = 0.0088）。对于双侧静脉狭窄患者，无缝合组生存率为66.7%（4/6），传统组为0%（0/2）（p = 0.10）。在3例发生全四支静脉狭窄的患者中，无缝合组仅1例存活。
虽然两组总体生存率相似，但TAPVC修复术后PVS的无缝合技术比传统手术方法成功挽救了更多肺静脉且未发生再狭窄。进一步随访可能会显示出该技术的治疗优势。
