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|本期目录/Table of Contents|

 利用“多余”冠状动脉纽片作主动脉根部成形在大动脉转位术中的应用()

《中国胸心血管外科临床杂志》[ISSN:1007-4848/CN:51-1492/R]

期数:
2010年第17卷第3期
页码:
182-187
栏目:
临床研究论著
出版日期:
2010-06-25

文章信息/Info

Title:
 Aortic Root Reconstruction with the Remaining Coronary Buttons in Arterial Switch Operation
文章编号:
1007-4848（2010）03-0182-06
作者:
 王顺民 徐志伟 刘锦纷 等
 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
Author(s):
 WANG Shun-min;  XU Zhi-wei;  LIU Jin-fen;  et al .
 Department of Thoracic and Cardiovascular Surgery, Shanghai Children’s Medical Center, Medical School of Shanghai Jiaotong University, Shanghai 200127, P.R. China
关键词:
 ; 大动脉错位;  大动脉转位术;  危险因素
Keywords:
 ; Transposition of great arteries;  Arterial switch operation;  Risk factor
分类号:
R654.1
DOI:
-
文献标识码:
A
摘要:
 目的 总结大动脉转位术（ASO）中利用“多余”的冠状动脉纽片作新主动脉根部成形的临床经验，探讨保持主动脉瓣窦的解剖形态对改善术后冠状动脉血流的临床意义。 方法 选取2003年1月至2009年6月，我院收治的室间隔缺损型大血管错位和TaussigBing畸形患者110例，手术年龄为出生2 d～2岁，平均年龄91.1 d；体重1.79～9.50 kg，平均体重4.70 kg。根据不同的外科处理技术，将患者分为两组，A组：78例，术中采用多余的冠状动脉纽片作新的主动脉根部成形，减小新主动脉根部近心端开口的直径；B组：32例，术中剪除多余的冠状动脉纽片，主动脉吻合口近心端与远心端直径不匹配。 采用logistic逐步回归筛选结果中影响住院死亡的危险因素。 结果 术后早期死亡12例，总病死率为10.9％（12/110），A组病死率明显低于B组 ［6.4%(5/78) vs. 21.9%(7/32)，P=0.019］。随访72例，随访时间为术后3个月～5年。后期死亡3例，A组1例，B组2例；5例患者再次手术。单因素logistic回归分析结果显示: 影响术后早期死亡的危险因子包括TaussigBing 畸形（χ2=4.011,P=0.046）、合并主动脉弓病变（χ2=4.437, P=0.036）、单支冠状动脉（χ2=5.071, P=0.025）和B组患者（χ2=5.584, P=0.019）。多因素logistic回归分析结果显示：合并主动脉弓病变 (χ2=5.681, P=0.010)和B组患者 (χ2=3.987, P=0.047)是构成影响术后早期死亡的独立危险因子。 结论 利用“多余”的冠状动脉纽片作新的主动脉根部成形能够较好地保持新主动脉瓣窦形态，而主动脉根部的特殊解剖形态与冠状动脉灌注有重要的关系，手术病死率降低可能与术后冠状动脉灌注得到改善有关。
Abstract:
 Objective To summarize the clinical experiences of using the remaining coronary buttons to reconstruct the neoaortic root in the arterial switch operation (ASO) and discuss the clinical significance of preserving the morphology of aortic sinus in improving postoperative coronary artery perfusion. Methods From January 2003 to June 2009, 110 patients with transposition of great arteries (TGA) combined with ventricular septal defect (VSD ) or the Taussig Bing anomaly treated in our hospital were enrolled in this study. The patients were at the age between 2 days and 2 years averaged 91.1 days, and their body weight varied between 1.79 and 9.50 kg with an average weight of 4.70 kg. The patients were divided into two groups based on different surgical strategies. For group A (n=78), we reconstructed the neoaortic root with the remaining coronary buttons by shortening the diameter of the proximal neoaorta. While for group B (n=32), we excised the remaining coronary buttons with the aortopulmonary diameter mismatched. The risk factors of hospital mortality were analyzed with stepwise logistic regression. Results Twelve patients died early after operation with a death rate of 10.9% (12/110). Mortality in group A was significantly lower than that in group B ［6.4%(5/78) vs. 21.9%(7/32)，P= 0.019］. Clinical followup was completed in 72 survivors with the followup time of 3 months to 5 years after operation. Late death occurred in 3 patients including 1 in group A and 2 in group B. Five patients underwent reoperations. Univariate logistic regression analysis showed that risk factors for early postoperative death were TaussigBing anomaly (χ2=4.011,P=0.046), aortic arch anomaly (χ2=4.437,P=0.036), single coronary artery pattern (χ2=5.071,P=0.025) and patients in group B (χ2=5.584, P= 0.019). Multivariate analysis confirmed that the aortic arch anomaly (χ2= 5.681, P=0.010 ) and patients in group B (χ2=3.987, P=0.047 ) were two independent risk factors for early mortality after operation. Conclusion The modified technique which uses the remaining coronary buttons to reconstruct the neoaortic root can preserve the morphology of neoaortic root better. The special anatomical morphology of aortic sinus has close relation to the perfusion of coronary arteries. The lowering hospital mortality may be due to the better perfusion of the coronary arteries.

参考文献/References

备注/Memo

备注/Memo:
更新日期/Last Update: 2010-07-06