摘要
目的总结分期双心室修补治疗远离大动脉室间隔缺损(noncommitted ventricular septal defect,ncVSD)型右心室双出口的手术治疗经验。方法回顾性分析2016年1月至2022年6月于上海交通大学医学院附属上海儿童医学中心接受分期双心室修补的19例ncVSD患儿的临床资料,其中男12例,女7例;中位手术年龄为54(12,203)个月;手术时中位体重为16.4(7.2,55.5)kg。患儿前期均接受姑息手术。患儿此次术前经皮氧饱和度为(85.8±6.1)%,范围为63%~96%;左室射血分数为(49.4±5.1)%,范围为41%~65%。患儿术前均完善心脏彩色多普勒超声及心脏CT检查,明确心脏及大血管结构发育情况后行终期手术。分析患儿术中、术后及随访资料,治疗前后比较采用独立样本t检验。结果所有患儿均顺利完成分期双心室修补,术中体外循环时间为(202.3±73.0)min,主动脉阻断时间为(113.0±31.2)min。2例患儿因体外循环停机困难术中予以体外膜肺氧合辅助循环,均于术后5 d顺利撤机。19例术后气管插管时间为(57.5±24.2)h,重症监护病房留滞时间为(8.1±4.7)d,住院时间为(22.1±9.4)d。19例患儿出院后随访(49.8±14.8)个月,随访期间无死亡病例;患儿经皮氧饱和度由术前(85.8±6.1)%提高至术后(96.5±1.6)%(t=–6.473,P=0.012);左室射血分数由术前(49.4±5.1)%提高至术后(61.1±4.1)%(t=–8.961,P=0.003)。患儿纽约心脏学会心功能分级均为Ⅰ~Ⅱ级;2例患儿分别于术后26、33个月因右心室流出道管道功能丧失予以更换。结论ncVSD患儿心脏解剖结构变异较大,部分单心室姑息术后患儿通过影像学检查精准评估心脏大血管空间结构及血流动力学情况,可于终期行双心室修补手术,术后中期随访效果令人满意。
Objective To summarize the surgical experience of staged biventricular repair for double outlet right ventricle(DORV)with noncommitted ventricular septal defect(ncVSD).Methods Clinical data of 19 children with ncVSD who underwent staged biventricular repair in the Shanghai Children's Medical Center,Shanghai Jiao Tong University School of Medicine,from January 2016 to June 2022 were retrospectively analyzed.Among them,12 were males and 7 were females,with a median surgical age of 54(12,203)months and a median weight of 16.4(7.2,55.5)kg at the time of surgery.All patients had previously undergone palliative procedures.Preoperative percutaneous oxygen saturation was 85.8%±6.1%(range:63%‑96%),and the left ventricular ejection fraction(LVEF)was 49.4%±5.1%(range:41%‑65%).All patients underwent preoperative cardiac Doppler ultrasound and computed tomography to assess the development of cardiac and major vessel structures before definitive surgery.Intraoperative,postoperative,and follow‑up data were analyzed,and intergroup comparisons were performed using independent samples t‑tests.Results All patients successfully completed staged biventricular repair.Cardiopulmonary bypass(CPB)time was 202.3±73.0 minutes,and aortic cross‑clamp time was 113.0±31.2 minutes.Two patients required extracorporeal membrane oxygenation support due to difficulty weaning from CPB,both of whom were successfully weaned within 5 days postoperatively.The postoperative tracheal intubation time,intensive care unit stay,and hospital stay for all 19 patients were 57.5±24.2 hours,8.1±4.7 days,and 22.1±9.4 days,respectively.During a follow‑up period of 49.8±14.8 months,no deaths occurred.Postoperative percutaneous oxygen saturation significantly improved from 85.8%±6.1%to 96.5%±1.6%(t=–6.473,P=0.012),and LVEF significantly increased from 49.4%±5.1%to 61.1%±4.1%(t=–8.961,P=0.003).All patients achieved the New York Heart Association(NYHA)functional class I–II.Two patients required right ventricular outflow tract conduit replacements at 26 and 33 months postoperatively due to conduit failure,respectively.Conclusions Children with ncVSD exhibit significant variations in cardiac anatomy.Some children initially managed with single‑ventricle palliation can undergo successful biventricular repair after precise imaging evaluation of cardiovascular spatial structure and hemodynamics,with satisfactory mid‑term follow‑up outcomes.
作者
罗凯
郑景浩
祝忠群
潘燕军
何晓敏
张晓阳
蔡及明
Luo Kai;Zheng Jinghao;Zhu Zhongqun;Pan Yanjun;He Xiaomin;Zhang Xiaoyang;Cai Jiming(Department of Cardiothoracic Surgery,Affiliated Shanghai Children's Medical Center,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China)
出处
《中华小儿外科杂志》
北大核心
2025年第7期581-586,共6页
Chinese Journal of Pediatric Surgery
基金
上海市市级医院新兴前沿技术联合公关项目(SHDC12021106)
上海市浦东新区科技发展基金(PKJ‑2021‑44)
上海市卫生健康委员会卫生行业临床研究专项面上项目(202040337)。
关键词
心脏缺损
先天性
右心室双出口
室间隔缺损
Heart defects,congenital
Double outlet of right ventricle
Ventricular septal defect
