室间隔完整的超龄大动脉转位病儿最佳手术方式的选择

目的 探讨超龄室间隔完整的大动脉转位(TGA-IVS)病儿手术方式的选择和治疗的早、中期结果.方法 2000年3月至2007年6月,收治年龄超过3周的TGA-IVS病儿36例,占同期TGA行动脉调转术(ASO)病儿的23.9%.男26例,女10例;年龄22～2190 d,其中小于3个月20例,大于1岁3例;体重3.5-19.0 kg,平均(5.4±2.9)kg.依据手术方式分为一期手术组(A组)21例和分期手术组(B组)15例.B组先进行左心室功能锻炼,二期再进行ASO,其中快速二期手术14例,长期二期手术1例.两组的平均年龄和术前左、右心室压力比值(LVP/RVP)差异有统计学意义.32例随访2-74个月,平均(20.3±19.1)个月.结果 围术期死亡2例,分别死于肺部感染和肾功能衰竭,巨细胞病毒感染引起的肝肾功能衰竭.术后3-6个月死亡3例,3年生存率为88.8%.生存病儿生活质量和生长发育良好,左心室收缩功能正常.结论 错过手术最佳时机的TGA-IVS病儿,参考术前超声和术中测压情况合理选择一期或分期ASO,并加强术后管理,治疗效果满意.

Optimal surgical management for transposition of great arteries with intact ventricular septum in infant older than 21 days

Objective To discuss the optimal surgical management for transposition of great arteries with intact ventricular septum (TGA-IVS) in infants older than 21 days. Methods Between March 2000 to June2007, 36 TGA-IVS infants older than 3 weeks including 20 cases younger than 3 month and 3 older than 1 year, were admitted. There were The mean body weight was (5.4±2.9)kg. All patients underwont artery swith operation (ASO), 21 patients in one-stage ASO (group A) and 15 in two-stsge ASO (group B). There was sisnificant different in mean age, body weight and LVP/RVP between two groups. Rapid two-stage ASO in 14 cases with banding of pulmonary artery and/no Blalock-Taussig shunts first and underdone ASO after (12.8±8.1) days. Long interval twostage ASO in 1 case who underdone ASO 6 months later because of LVEF less than 40%. Median follow-up time was 20.3 (2-74) months. Results There were2 early deaths (1 from group Aand 1 from gronp B) and3 late deaths (all from gronp A). The actuarial survival rate was 88.8% at 3 years. Conclusion Decided on the basis of preoperative ultrasound and intraoperative pressure mea- surement, one or two-stage ASO may provide satisfactory effect on transpositon of great arteries with intact ventricular septum in infants elder than 21 days.