大动脉调转术手术时机对室间隔完整的完全性大动脉转位患儿预后的影响

目的评价大动脉调转术（anerial switch operation，ASO）手术时机对室间隔完整的完全性大动脉转位（transposition of the great arteries with intact ventricular septum，TGA／IVS）患儿预后的影响。方法选取2005年1月至2009年12月在广东省人民医院行ASO的TGA／IVS患儿72例，依手术时年龄分为3组：I组年龄≤7d，Ⅱ组年龄7～14d，Ⅲ组年龄〉14d。回顾性分析各组术后围术期并发症、早期死亡、中期死亡及再次手术干预等情况。结果各组患儿在术后低心排血量综合征、膈肌麻痹、肺不张、肾功能衰竭、切口愈合不良等并发症发生率比较，差异无统计学意义（P〉0．05）。3组早期病死率分别为30-8％（8／26），11．1％（3／27）及0％，3组比较差异有统计学意义（P〈0．005）。共61例出院患儿，随访率为91．8％（56／61）。3组各有1例因术后肺动脉狭窄需再次手术干预，3组再次手术干预率比较，差异无统计学意义（P〉0．05）。I、Ⅱ组患者均无中期死亡，Ⅲ组中期病死率为6．7％（1／15）。结论TGA／IVS患儿ASO术后早期病死率仍较高，中期预后好；手术年龄不是TGA／IVS手术时机的决定性因素。

Impact of surgical timing on outcomes following primary arterial switch operation in infants with transposition of the great arteries with intact ventricular septum

Objectives To assess the impact of surgical timing on outcomes following primary arterial switch operation(ASO) in infants with transposition of the great arteries with intact ventricular septum(TGA/IVS).Methods In this retrospective study,clinical data of 72 consecutive patients with TGA/IVS undergoing primary ASO from January 2005 to December 2009 in Guangdong General Hospital were analyzed.They were divided into 3 groups according to the surgical age.Group I was for surgical age within 7 days,group Ⅱ and group Ⅲ were for surgical ages 7 to 14 days and more than 14 days respectively.Perioperative complications,early mortality,mid-term mortality and reintervention were analyzed retrospectively.Results There were no significant differences in incidence rate of low cardiac output syndrome,diaphragmatic paralysis,atelectasis,renal failure and surgical wound healing among the three groups(P>0.05).There were significant differences in early mortality among the three groups group I 30.8%(8/26),group Ⅱ 11.1%(3/27) and group Ⅲ 0%,P<0.005].There was one reintervention in each group,and the reintervention rate had no significant difference among the three groups(P>0.05).Mid-term outcome data were available for 56 discharged infants follow-up rate: 91.8%(56/61)].There was no mid-term mortality in group Ⅰ and group Ⅱ,but one in gruop Ⅲ(6.7%,1/15).Conclusions Early mortality following ASO is still high in infants with TGA/IVS.Mid-term outcome is good.Age is not the key factor for surgical timing in infants with TGA/IVS.