不同类型姑息手术对完全性大动脉转位合并左心室流出道狭窄患儿左心室流出道和肺动脉发育的影响

目的:分析不同类型姑息手术对完全性大动脉转位合并左心室流出道狭窄(TGA/LVOTO)患儿的肺动脉和左心室流出道生长发育的影响。方法:回顾性纳入2012年1月1日至2017年1月1日期间在我院接受改良体肺分流术(改良BT分流术,BT亚组,n=16)和腔肺分流术(双向Glenn手术,Glenn亚组,n=8)后再接受根治术(姑息手术组,n=24)和直接接受一期根治术(一期根治组,n=30)的患儿,收集各组患儿在姑息手术前(一期根治组为出生后首次体检时间并作为初次记录时间)和根治术前(再次记录时间)的肺动脉内径(包括主肺、右肺、左肺动脉)和肺动脉瓣环(PV)内径的临床资料,对比各组间在该观察期间临床数据变化速度的差异。结果:从初次记录时间点到再次记录时间点期间,一期根治组患儿的PV内径z值不断减小;姑息手术组中BT亚组患儿的PV内径z值和左肺动脉内径z值不断增大,且z值变化速度与一期根治组比较差异均有统计学意义(P均<0.05);姑息手术组中Glenn亚组患儿PV内径z值不断减小,且z值变化速度与BT亚组比较差异有统计学意义(P<0.05),但与一期根治组比较差异无统计学意义(P>0.05)。结论:延迟根治术会加重TGA/LVOTO患儿LVOTO程度,改良BT分流术可促进TGA/LVOTO患儿左肺动脉和左心室流出道的发育,而双向Glenn手术不能促进TGA/LVOTO患儿肺动脉和左心室流出道的发育。因此,对于无法一期根治的TGA/LVOTO患儿,选择改良BT分流术作为姑息性手术更加合理。

Impact of Different Palliation Procedures on Left Ventricular Outflow Tract and Pulmonary Artery Remodeling in Children With Complete Transposition of the Great Arteries Complicating With Left Ventricular Outflow Tract Obstruction

Objectives: To evaluate the impact of different palliation procedures on left ventricular outflow tract and pulmonary artery remodeling in children with complete transposition of the great arteries complicating with left ventricular outflow tract obstruction(TGA/LVOTO).Methods: Clinical data at before palliation procedures or first medical examination after birth and before anatomic repair of patients who received palliation procedure(experimental group, 16 modified BT shunt and 8 bidirectional Glenn operation,followed by anatomic repair) and patients who received one-stage anatomic repairs(control group, n=30).Results: During the time from the palliation procedure(the first physical examination in control group) to anatomic repair, the PV z value of patients in control group decreased gradually, while in BT group, the z value of PV and LPA increased gradually(P=0.038, P=0.048, respectively), the PV z value in Glenn group decreased gradually(P<0.05 vs BT group), and there was no significant difference between Glenn group and control group(P>0.05).Conclusions: The delayed anatomic repair can aggravate the obstruction of LVOT, the modified BT shunt can promote the growth of PV and LPA, while the bidirectional Glenn procedure cannot promote the growth of PV and PA of TGA/LVOTO patients.