完全性肺静脉异位引流手术预后的病例对照研究

目的 探讨完全性肺静脉异位引流(TAPVD)的临床特点和手术治疗效果。方法 2012年6月至2018年6月于我院住院行外科手术治疗并符合纳入标准的TAPVD患儿,分为事件组(发生终点事件)和非事件组(未发生终点事件)。采用SPSS 25软件进行数据分析,计量资料用中位数表示。组间比较用Mann-Whitney U检验。应用COX多因素回归分析发生终点事件的危险因素。结果 138例TAPVD患儿纳入分析,心上型65例,心内型44例,心下型19例和混合型10例,手术年龄中位数50 d,<6月龄123例(89.1%),<1月龄60例(43.5%)。事件组42例,非事件组96例。术前存在肺静脉梗阻(PVO)患儿63例(45.7%),术后发生PVO患儿41例(29.7%)。心下型、混合型、手术年龄、术前存在POV、需要急诊手术及体外循环时间在事件组与非事件组之间分布差异有统计学意义。COX多因素回归分析结果显示心下型(P=0.005)、混合型(P=0.014)、术前存在PVO(P=0.020)、手术年龄<1月龄(P=0.009)及体外循环时间长(P=0.024)是发生终点事件的危险因素。结论 心上型是最常见的TAPVD类型,心下型、混合型、术前存在PVO、手术年龄<1月龄及体外循环时间长是预后差的危险因素。

The clinical characteristics and surgical outcomes of total anomalous pulmonary venous drainage

Objective To analyze the clinical characteristics and surgical outcomes of total anomalous pulmonary venous drainage (TAPVD).Methods We reviewed patients with TAPVD from June 2012 to June 2018 who underwent surgical repair and met the inclusion criteria. The patients were classified into 2 groups: event and nonevent group. Data were analyzed with SPSS statistical software and median (range) was used to describe the data distributions which do not conform to normal distribution. The Mann-Whitney U test was used to compare differences between groups. Cox proportional hazards modeling was used to analyze associated risk factors for death and recurrent pulmonary venous obstruction (PVO).Results A total of 138 patients with TAPVD were recruited including 42 cases in event group and 96 cases in nonevent group. There were 65 cases with supracardiac type, 44 cases with intracardiac type, 19 cases with infracardiac type and 10 cases with mix type. A total of 138 patients underwent TAPVD repair at a median age of 50 days; patients younger than 1 month were 60 cases (43.5%) and younger than 6 months were 123 cases (89.1%).There were 63 cases (45.7%) with preoperative PVO and 41 cases (29.7%) with postoperative PVO. Infracardiac TAPVD, mixed TAPVD, younger age, preoperative PVO, emergency operation and prolonged cardiopulmonary bypass showed significant difference between the event and nonevent groups. The preoperative predictors of studied endpoints were infracardiac TAPVD (P=0.005), mixed TAPVD (P=0.014), preoperative PVO (P=0.020), younger than 1 month (P=0.009) and prolonged cardiopulmonary bypass (P=0.024).Conclusions upracardiac subtype is the most common type of TAPVD. Risk factors such as infracardiac, mixed TAPVD, preoperative PVO, younger than 1 month at repair and prolonged cardiopulmonary bypass, were associated with a poorer prognosis.