大动脉转位术后吻合口生长的随访研究

目的随访分析大动脉转位术（ASO）后的主动脉（AO）、肺动脉（PA）吻合口生长情况，以了解ASO术后的长期疗效。方法回顾性分析自1999年12月至2007年12月上海交通大学医学院附属上海儿童医学中心施行ASO 331例患者的相关资料，其中完全性大动脉错位合并室间隔完整型（TGA／IVS）111例，完全性大动脉错位合并室间隔缺损（TGA／VSD）123例，右心室双出口伴肺动脉瓣下室间隔缺损、肺动脉高压（Taussig-Bing）73例，快速二期大动脉转位术（Stage-Switch）24例。随访228例，随访时间20．4±18．6个月；随访超声心动图报告752张，平均每例随访3．3次。根据超声心动图所测AO、PA吻合口直径大小，分析吻合口的生长情况。结果TGA／IVS患者AO、PA吻合口直径（近期为0．74±0．17cm和0．65±0．13cm，远期1．09±0．31cm和0．84±0．21cm），TGA／VSD患者AO、PA吻合口直径（近期为0．76±0．20cm和0．63±0．14cm，远期为1．09±0．24cm和0．82±0．22cm），Taussig-Bing患者AO、PA吻合口直径（近期为0．84±0．25cm和0．74±0．20cm，远期为1．05±0．30cm和0．85±0．24cm）远期较近期均有明显生长（P〈0．05）；Stage—Switch患者AO吻合口直径（近期为0．93±0．19cm，远期为1．19±0．29cm）远期相对于近期有明显生长（P〈0．05），PA吻合口直径（近期为0．90±0．27cm，远期为1．00±0．32cm）远期较近期有生长，但差异无统计学意义（P〉0．05）。随访至2008年11月，共有6例患者因左、右心室流出道梗阻而需再次手术，术后有3例无残余梗阻，3例仍有残余梗阻。结论ASO的主动脉和肺动脉离断再缝合连接之后，血管能够随着年龄增加而生长，但也会发生狭窄。在长期随访中，有个别患者需要再次手术干预。

Follow-up Study on the Growth of Anastomotic Stoma after Arteries Switch Operation

Objective To analyze the growth of anastomotic stoma of aortic（AO） and pulmonary artery （PA） after arteries switch operation（ASO） so as to assess the long-term efficacy of ASO . Methods The data of 331 patients who had undergone ASO in Shanghai Children＇s Medical Center of Jiaotong University from December 1999 to December 2007 was analysed retrospectively. One hundred eleven patients had complete transposition of great arteries complicated with intact ventricular septum（TGA/IVS）, 123 had complete transposition of great arteries complicated with ventricular septal defect （TGA/VSD）, 73 had Taussig-Bing complicated with ventricutar septal defect and pulmonary hypertension, and 24 underwent Stage-Switch. Of the 331 patients 228 were followed-up, and the follow-up time was 20.4±18.6 months. There were 752 ultrasonic cardiograph reports, 3.3 per patient on average. The growth of anastomosis was analysed according to the diameters of AO and PA. Results The AO and PA anastomosis diameters of TGA/IVS patients（before discharge 0.74±0.17 cm and 0.65±0.13 cm, latest follow-up 1.09±0.31cm and 0.84±0.21 cm）, TGA/VSD patients （before discharge 0. 76 ± 0.20 cm and 0. 63 ±0. 14 cm, latest follow-up 1.09±0.24 cm and 0.82±0.22 em） and Taussig Bing patients（before discharge 0.84±0.25 cm and 0.74±0. 20 cm, latest follow-up 1.05±0.30 cm and 0. 85 ± 0. 24 cm） growed significantly（P〈0.05）. The AO anastomotic stoma diameters of patients who had underwent Stage-Swtich （before discharge 0.93±0. 19 cm, latest follow-up 1.19±0.29 cm） growed significantly（P±0.05）. The PA anastomotic stoma diameter growed（before discharge 0. 90±0. 27 cm, latest follow-up 1.00±0.32 cm）, but had no statistical significance （P〉0. 05）. Till November 2008, Six patients needed reoperation because of the right or left ventricle outflow tract obstruction. After reoperation, 3 had no residual obstruction, 3 had residual obstruction. Conclusion After the section and suture of ASO, aortic and pu