大动脉调转术后吻合口梗阻的影响因素

目的 分析大动脉调转术后主动脉和肺动脉吻合口梗阻的影响因素.方法 1999年12月至2007年12月,行大动脉调转术(ASO)331例,术后生存288例.228例平均随访(20.4±18.6)个月,随访率79.2%.根据ASO术后超声报告所测主、肺动脉吻合口流速的大小,对完全性大血管错位室间隔完整型(TGA/IVS),完全性大血管错位伴窒间隔缺损(TGA/VSD),右室双出口伴肺动脉瓣下室间隔缺损、肺动脉高压(Taussig-Bing)和快速二期大动脉调转术(Stage-Switch)的随访资料分别分析其主、肺动脉吻合口的梗阻情况.对ASO手术后的各类疾病的主动脉和肺动脉吻合口流速,按流速<2 m/s,2～3 m/s,>3 m/s的病例百分数进行统计分析.结果 4种疾病分类的随访结果示主动脉吻合口流速差异有统计学意义(P=0.034),肺动脉吻合口流速差异无统计学意义(P>0.05).肺动脉吻合口流速增快发生率比主动脉吻合口高.Taussig-Bing组发生率高,Stage-Switch组发生率低.手术时病婴年龄越小(≤12 d),主动脉、肺动脉吻合口流速越易增快.随访时间延长,流速增快的发生率会逐渐提高.全组6例由于左、右流出道梗阻而再次手术.结论 ASO术后,肺动脉吻合口梗阻发生率较高.ASO术后必须定期随访,注意观测吻合口的生长情况.

Prediction of aortic and pulmonary anastomoses stenosis after arterial switch operation

Objective To analyze the stenosis of aortic and pulmonary anastomosis after arterial switch operation ( ASO). Methods A retrospective review was performed on 228 patients who had an ASO for the complete transposition of the great arteries and intact ventricular septum (TGA/IVS).transposition with ventricular septum defect (TGA/VSD),double outlet right ventricular with subpulmonary VSD (Taussig-Bing) and stage-switch operation from 1999 to 2007. Data including hospital histories, operation records,echocardiograms( ECHO) before and after operation were collected. Mean follow-up time is (20.4 ±18.6) months (1 month, 88 months). We analyze the development of obstruction according to the flow velocity in echo reports into three groups: flow velocity < 2 m/s ,2-3 m/s, > 3 m/s. Results The proportion of aorta anastomosis flow velocity >3 m/s is different in Taussig-Bing, TGA/IVS, TGA/VSD and Stage-Switch (P =0.034). The flow velocity >3 m/s happens mostly in Taussig-Bing. The proportion of flow velocity ( >3 m/s) at pulmonary anastomosis (9.2% ) is higher than at aorta (3.1% ). The flow velocity at anastomosis is likely to increase if operation age is below 12 days. Six patients were reoperated on for stenosis of pulmonary anastomosis after ASO operation for outflow obstruction. Conclusion The proportion of pulmonary anastomoses stenosis is higher than aortic anastomoses stenosis after ASO operation. It is important that the patients after ASO operation must be followed-up termly to check the anastomosis of pulmonary and aorta.