上海交通大学学报（医学版）

›› 2011, Vol. 31 ›› Issue (9): 1269-.doi: 10.3969/j.issn.1674-8115.2011.09.013

• 论 著 • 上一篇    下一篇

单心室手术治疗内脏异位综合征早期死亡危险因素分析

黄继红, 苏肇伉, 王亮君, 周燕萍   

  1. 上海交通大学 医学院附属上海儿童医学中心胸外科, 上海 200127
  • 出版日期:2011-09-28 发布日期:2011-09-27
  • 作者简介:黄继红（1971—）, 女, 主治医师, 博士生；电子信箱: jh-huang2000@sohu.com。

Analysis of risk factors for early mortality in patients with single ventricle series palliation for heterotaxy syndrome

HUANG Ji-hong, SU Zhao-kang, WANG Liang-jun, ZHOU Yan-ping   

  1. Department of Pediatric 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

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摘要：

目的 分析单心室系列手术治疗内脏异位综合征早期死亡的危险因素。方法 回顾性分析上海儿童医学中心2004年1月—2011年1月连续61例内脏异位综合征患儿接受单心室系列手术的临床资料，分析手术早期死亡的危险因素。单心室系列手术包括体肺分流、肺动脉环缩、双向腔肺分流术、改良Fontan手术以及Kawashima手术；早期死亡指第1次手术至Fontan术后30 d内死亡。结果 术后早期死亡病例共8例，病死率为13.1％。其中左心房异构死亡1例，右心房异构死亡7例；新生儿期手术死亡2例，双向腔肺分流术后死亡1例，改良Fontan术后死亡5例。多因素Cox回归分析表明：新生儿期手术（危险比5.56，P=0.04）、梗阻性肺静脉异位引流（危险比18.21，P=0.02）、中度以上房室瓣反流（危险比12.31，P=0.03）与内脏异位综合征的术后早期死亡相关。结论 左心房异构手术效果优于右心房异构，内脏异位综合征术后早期死亡危险因素为新生儿期手术、合并梗阻性肺静脉异位引流和中度以上房室瓣反流。

关键词: 内脏异位综合征, 手术, 危险因素

Abstract:

Objective To analyse the risk factors for early mortality in patients with heterotaxy syndrome undergoing single ventricle series palliation. Methods The clinical data of 61 consecutive patients with heterotaxy syndrome undergoing single ventricle palliation in Shanghai Children's Medical Center from January 2004 to January 2011 were retrospectively reviewed, and the risk factors for early mortality after operation were analysed. Single ventricle series palliation included Blalock shunt, pulmonary artery band, bidirectional cava-pulmonary shunt, modified Fontan and Kawashima procedure. Early mortality was recorded as a death event from the first surgical procedure to 30 d after Fontan operation. Results There were 8 early death events, with the early mortality of 13.1%. Among the 8 cases, one was left atrial isomerism, and the other 7 were right atrial isomerism; 2 occurred after neonatal operation, 1 occurred after bidirectional cavapulmonary shunt, and the other 5 occurred after modified Fontan. Multivariate Cox regression analysis revealed that neonatal operation (hazard ratio, 5.56; P=0.04), obstructed anomalous pulmonary venous drainage (hazard ratio, 18.21; P=0.02) and greater than moderate atrioventricular valve regurgitation (hazard ratio,12.31; P=0.03) were associated with early mortality after operation in heterotaxy syndrome. Conclusion The surgical outcome of left atrial isomerism may be better than that of right atrial isomerism. Neonatal operation, obstructed anomalous pulmonary venous drainage and greater than moderate atrioventricular valve regurgitation are risk factors for early mortality after operation in heterotaxy syndrome.

Key words: heterotaxy syndrome, surgery, risk factor