上海交通大学学报（医学版）

›› 2011, Vol. 31 ›› Issue (9): 1250-.doi: 10.3969/j.issn.1674-8115.2011.09.008

• 论 著 • 上一篇    下一篇

年龄大于3周的室间隔完整的完全性大动脉转位患儿行大动脉调转术后疗效分析

解 锋, 陈会文, 刘锦纷   

  1. 上海交通大学 医学院附属上海儿童医学中心心胸外科, 上海 200127
  • 出版日期:2011-09-28 发布日期:2011-09-27
  • 通讯作者: 刘锦纷, 电子信箱: liuJinfen2002@yahoo.com。
  • 作者简介:解 锋（1983—）, 男, 硕士生；电子信箱: xie50202090@sina.com。
  • 基金资助:

    上海市科委基金（09ZR1419500）

Primary arterial switch operation for D-transposition of the great arteries with intact ventricular septum in children older than 3 weeks

XIE Feng, CHEN Hui-wen, LIU Jin-fen   

  1. Department of Cardiovascular and Thoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
  • Online:2011-09-28 Published:2011-09-27
  • Supported by:

    Shanghai Science and Technology Committee Foundation, 09ZR1419500

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摘要：

目的 评估大动脉调转术（ASO）对年龄>3周的室间隔完整（IVS）的完全性大动脉转位（DTGA）患儿的治疗效果，探讨螺旋心肌带（HVMB）理论在诊治DTGA/IVS中的意义。方法 分析54例年龄为3周~16个月（晚期ASO组）和74例年龄<3周（早期ASO组）的DTGA/IVS患儿的临床资料。晚期ASO组中，20例室间隔平直或者偏向左，纳入室间隔偏移（VSM）组；34例室间隔形态保持正常，纳入室间隔正常（VSN）组。评估ASO的治疗效果。结果 晚期ASO组与早期ASO组比较，体外循环时间、主动脉钳夹时间以及术后呼吸机应用时间、监护时间、住院时间、病死率比较，差异均无统计学意义（P>0.05）。VSM组的术后病死率为10.0%，VSN组的术后病死率为8.8%，差异无统计学意义（P>0.05）。结论 ASO对年龄为3周~16个月的DTGA/IVS 患儿疗效确切。室间隔正常形态的保持对于DTGA/IVS 患儿ASO预后的意义重大，HVMB理论可以很好地解释这一现象。

关键词: 完全性大动脉转位, 大动脉转位术, 螺旋心肌带, 室间隔

Abstract:

Objective To assess the outcomes of primary arterial switch operation (ASO) in treatment of D-transposition of the great arteries (DTGA) with intact ventricular septum (IVS) in children older than 3 weeks, and explore the significance of helix ventricular myocardial band (HVMB) in the treatment of DTGA/IVS. Methods The clinical data of 54 children with DTGA/IVS aged between 3 weeks and 16 months (late ASO group) and 74 children with DTGA/IVS aged less than 3 weeks (early ASO group) were analysed. In late ASO group, children were subdivided into ventricular septal migration (VSM) group (n=20, ventricular septa were straight or skewed to the left) and ventricular septal normal (VSN) group (n=34, ventricular septa were normal in appearance). The surgical outcomes of ASO were evaluated. Results There was no significant difference in time of extracorporeal circulation, time of aortic clamping, time of ventilator application after operation, time of intensive care after operation, duration of hospitalization and mortality between late ASO group and early ASO group (P＞0.05). There was no significant difference in mortality between VSM group and VSN group (10.0% vs 8.8%, P＞0.05). Conclusion Primary ASO may be appropriate treatment for children with DTGA/IVS aged between 3 weeks and 16 months, and the normal appearance of ventricular septa plays an important role in the outcomes, which can be well explained by the theory of HVMB.

Key words: D-transposition of the great arteries, arterial switch operation, helix ventricular myocardial band, ventricular septal