完全性肺静脉异位引流手术预后的病例对照研究

doi:10.3969/j.issn.1673-5501.2019.05.010

摘要/Abstract

摘要： 目的探讨完全性肺静脉异位引流(TAPVD)的临床特点和手术治疗效果。方法 2012年6月至2018年6月于我院住院行外科手术治疗并符合纳入标准的TAPVD患儿,分为事件组(发生终点事件)和非事件组(未发生终点事件)。采用SPSS 25软件进行数据分析,计量资料用中位数表示。组间比较用Mann-Whitney U检验。应用COX多因素回归分析发生终点事件的危险因素。结果 138例TAPVD患儿纳入分析,心上型65例,心内型44例,心下型19例和混合型10例,手术年龄中位数50 d,<6月龄123例(89.1%),<1月龄60例(43.5%)。事件组42例,非事件组96例。术前存在肺静脉梗阻(PVO)患儿63例(45.7%),术后发生PVO患儿41例(29.7%)。心下型、混合型、手术年龄、术前存在POV、需要急诊手术及体外循环时间在事件组与非事件组之间分布差异有统计学意义。COX多因素回归分析结果显示心下型(P=0.005)、混合型(P=0.014)、术前存在PVO(P=0.020)、手术年龄<1月龄(P=0.009)及体外循环时间长(P=0.024)是发生终点事件的危险因素。结论心上型是最常见的TAPVD类型,心下型、混合型、术前存在PVO、手术年龄<1月龄及体外循环时间长是预后差的危险因素。

关键词: 肺静脉梗阻, 完全性肺静脉异位引流, 先天性心脏病

Abstract: Objective To analyze the clinical characteristics and surgical outcomes of total anomalous pulmonary venous drainage (TAPVD).Methods We reviewed patients with TAPVD from June 2012 to June 2018 who underwent surgical repair and met the inclusion criteria. The patients were classified into 2 groups: event and nonevent group. Data were analyzed with SPSS statistical software and median (range) was used to describe the data distributions which do not conform to normal distribution. The Mann-Whitney U test was used to compare differences between groups. Cox proportional hazards modeling was used to analyze associated risk factors for death and recurrent pulmonary venous obstruction (PVO).Results A total of 138 patients with TAPVD were recruited including 42 cases in event group and 96 cases in nonevent group. There were 65 cases with supracardiac type, 44 cases with intracardiac type, 19 cases with infracardiac type and 10 cases with mix type. A total of 138 patients underwent TAPVD repair at a median age of 50 days; patients younger than 1 month were 60 cases (43.5%) and younger than 6 months were 123 cases (89.1%).There were 63 cases (45.7%) with preoperative PVO and 41 cases (29.7%) with postoperative PVO. Infracardiac TAPVD, mixed TAPVD, younger age, preoperative PVO, emergency operation and prolonged cardiopulmonary bypass showed significant difference between the event and nonevent groups. The preoperative predictors of studied endpoints were infracardiac TAPVD (P=0.005), mixed TAPVD (P=0.014), preoperative PVO (P=0.020), younger than 1 month (P=0.009) and prolonged cardiopulmonary bypass (P=0.024).Conclusions upracardiac subtype is the most common type of TAPVD. Risk factors such as infracardiac, mixed TAPVD, preoperative PVO, younger than 1 month at repair and prolonged cardiopulmonary bypass, were associated with a poorer prognosis.

Key words: Congenital heart disease, Pulmonary venous obstruction, PVO, Total anomalous pulmonary venous drainage, TAPVD

党艳, 张璟, 高燕, 曾子倩, 杨佳伦, 马晓静. 完全性肺静脉异位引流手术预后的病例对照研究[J]. 中国循证儿科杂志, 2019, 14(5): 371-373.

DANG Yan, ZHANG Jing, GAO Yan, ZENG Zi-qian, YANG Jia-lun, MA Xiao-jing. The clinical characteristics and surgical outcomes of total anomalous pulmonary venous drainage[J]. Chinese Journal of Evidence -Based Pediatric, 2019, 14(5): 371-373.

参考文献

[1] Reller MD, Strickland MJ, Riehle-Colarusso T, et al. Prevalence of congenital heart defects in metropolitan Atlanta, 1998-2005. J Pediatr, 2008, 153(6): 807-813
[2] Shi G, Zhu Z, Chen J, et al. Total Anomalous Pulmonary Venous Connection: The Current Management Strategies in a Pediatric Cohort of 768 Patients. Circulation, 2017, 135(1): 48-58
[3] Harada T, Nakano T, Oda S, et al. Surgical results of total anomalous pulmonary venous connection repair in 256 patients. Interact Cardiovasc Thorac Surg, 2019, 28(3): 421-426
[4] Craig JM, Darling RC, Rothney WB. Total pulmonary venous drainage into the right side of the heart: report of 17 autopsied cases not associated with other major cardiovascular anomalies. Lab Invest, 1957, 6(1): 44-64
[5] 黄国英. 小儿超声心动图学. 上海: 上海科学技术出版社, 2015: 174-185
[6] Hoashi T, Kagisaki K, Kurosaki K, et al. Intrinsic obstruction in pulmonary venous drainage pathway is associated with poor surgical outcomes in patients with total anomalous pulmonary venous connection. Pediatr Cardiol, 2015, 36(2): 432-437
[7] White BR, Ho DY, Faerber JA, et al. Repair of Total Anomalous Pulmonary Venous Connection: Risk Factors for Postoperative Obstruction. Ann Thorac Surg, 2019, 108(1): 122-129
[8] 欧艳秋, 聂志强, 庄健, 等. 单中心328例不同分型完全性肺静脉异位引流的临床特点和外科治疗早中期结果. 中华胸心血管外科杂志, 2017, 33(1): 10-15
[9] Hoashi T, Kagisaki K, Kurosaki K, et al. Intrinsic obstruction in pulmonary venous drainage pathway is associated with poor surgical outcomes in patients with total anomalous pulmonary venous connection. Pediatr Cardiol, 2015, 36(2): 432-437
[10] Ho DY, White BR, Glatz AC, et al. Postoperative Obstruction of the Pulmonary Veins in Mixed Total Anomalous Pulmonary Venous Connection. Pediatr Cardiol, 2018, 39(7): 1489-1495
[11] Hörer J, Neuray C, Vogt M, et al. What to expect after repair of total anomalous pulmonary venous connection: data from 193 patients and 2902 patient years. Eur J Cardiothorac Surg, 2013, 44(5): 800-807
[12] Wu Y , Wu Z, Zheng J, et al. Sutureless technique versus conventional surgery in the primary treatment of total anomalous pulmonary venous connection: a systematic review and meta-analysis. J Cardiothorac Surg, 2018, 13(1): 69
[13] Zhang C, Ou Y, Zhuang J, et al. Comparison of Sutureless and Conventional Techniques to Repair Total Anomalous Pulmonary Venous Connection. Semin Thorac Cardiovasc Surg, 2016, 28(2): 473-484
[14] 李晓华, 陈寄梅, 庄健, 等. Sutureless技术在新生儿完全性肺静脉异位引流中的应用. 中国胸心血管外科临床杂志, 2017, 24(9): 661-666
[15] Yoshimura N, Fukahara K, Yamashita A, et al. Surgery for total anomalous pulmonary venous connection: primary sutureless repair vs. conventional repair. Gen Thorac Cardiovasc Surg, 2017, 65(5): 245-251
[16] Karamlou T, Gurofsky R, Al Sukhni E, et al. Factors associated with mortality and reoperation in 377 children with total anomalous pulmonary venous connection. Circulation, 2007, 115(12): 1591-1598
[17] Sakamoto T, Nagashima M, Umezu K, et al. Long-term outcomes of total correction for isolated total anomalous pulmonary venous connection: lessons from 50-years' experience. Interact Cardiovasc Thorac Surg, 2018, 27(1): 20-26
[18] St Louis JD, Harvey BA, Menk JS, et al. Repair of "simple" total anomalous pulmonary venous connection: a review from the Pediatric Cardiac Care Consortium. Ann Thorac Surg, 2012, 94(1): 133-138
[19] Seale AN, Uemura H, Webber SA, et al. Total anomalous pulmonary venous connection: morphology and outcome from an international population-based study. Circulation, 2010, 122(25): 2718-2726
[20] Zhao K, Wang H, Wang Z, et al. Early-and intermediate-term results of surgical correction in 122 patients with total anomalous pulmonary venous connection and biventricular physiology. J Cardiothorac Surg, 2015, 10: 172
[21] Yong MS, d'Udekem Y, Robertson T, et al. Outcomes of surgery for simple total anomalous pulmonary venous drainage in neonates. Ann Thorac Surg, 2011, 91(6): 1921-1927