非体外循环下肺动脉瓣切开术初期治疗室间隔完整型肺动脉闭锁的单中心临床分析

目的评价非体外循环下肺动脉瓣切开术在室间隔完整型肺动脉闭锁(PA/IVS)初期手术治疗中的疗效。方法回顾性分析2013年1月至2019年9月于我院行非体外循环下右心室减压术的61例PA/IVS患儿的临床资料,男37例、女24例,年龄29.7(2.0~86.0)d,体重4.1(2.5~6.9)kg。其中39例行非体外循环下肺动脉瓣切开术(直视切开组),22例行经右心室肺动脉瓣穿刺球囊扩张成形术(镶嵌治疗组)。比较两组患儿术后死亡率、早期再干预率以及终期手术情况等。结果全组共2例死亡,死亡率3.3%(2/61),直视切开组和镶嵌治疗组各死亡1例,两组死亡率差异无统计学意义(2.6%vs.4.5%,P=0.68)。两组在早期再干预率(5.3%vs.19.0%,P=0.09)、气管插管时间[(56.0±25.9)h vs.(62.0±28.9)h,P=0.41]、ICU滞留时间[(4.7±2.9)d vs.(5.5±2.2)d,P=0.23]、住院时间[(3.9±0.9)d vs.(4.3±1.1)d,P=0.38]等方面差异无统计学意义。随访时间45.3(4.0~84.0)个月,共5例失访。随访期间,直视切开组17例患者无需再手术,13例已完成终期手术,镶嵌治疗组7例患者无需再手术,8例完成终期手术,两组心功能分级(NYHA)均为Ⅰ~Ⅱ级。结论非体外循环下肺动脉瓣切开术与镶嵌治疗相比同样具有操作简便、手术时间短、手术成功率高等特点,且因更经济实惠及再干预率相对偏低,可能更易于临床推广应用。

Effect of off-pump pulmonary valvotomy as the initial surgery for pulmonary atresia with intact ventricular septum:A single-center clinical analysis

Objective To evaluate the effect of off-pump pulmonary valvulotomy for the patients with pulmonary atresia with intact ventricular septum(PA/IVS).Methods The clinical data of 61 PA/IVS patients who underwent off-pump right ventricular decompression surgery in our hospital from January 2013 to September 2019 were retrospectively analyzed,including 37 males and 24 females,with an average age of 29.7(2.0-86.0)d and weight of 4.1(2.5-6.9)kg.Thirty-nine patients received off-pump pulmonary valvulotomy(an open-view valvulotomy group)and 22 patients received balloon valvuloplasty through the right ventricle pulmonary valve(a hybrid therapy group).The postoperative mortality,early re-intervention,and completion of final operation of the two groups were compared.Results There were 2 deaths in the study with a mortality rate of 3.3%(2/61),and the mortality rate of the two groups was not significantly different(2.6%vs.4.5%,P=0.68).The rate of early re-intervention in the two groups was 5.3%and19.0%,respectively(P=0.09).There was no statistical difference in intubation time(56.0±25.9 h vs.62.0±28.9 h,P=0.41),ICU retention time(4.7±2.9 d vs.5.5±2.2 d,P=0.23)and postoperative hospital stay time(3.9±0.9 d vs.4.3±1.1 d,P=0.38)between the two groups.The follow-up time was 45.3(4.0-84.0)months.There were 5 patients lost to follow-up.During the follow-up period,in the open-view valvulotomy group,17 patients did not need further operation,13 patients completed the final operation.In the hybrid therapy group,7 patients did not need further operation,8 patients completed the final operation.Heart function classification of all patients was in New York Heart Association classⅠ-Ⅱ.Conclusion Compared with the hybrid therapy,off-pump pulmonary valvulotomy for PA/IVS also has the advantages of simple operation,short operation time and high survival rate,and it may be easier to be promoted in clinical application because of its more economic benefits and relatively lower re-intervention rate.