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目的评价大动脉调转术(ASO)手术时机对并室间隔缺损的完全性大动脉转位(TGA/VSD)患儿预后的影响。方法选取2005年1月-2009年12月在本院行ASO的TGA/VSD患儿62例,依手术时年龄分为早期组(≤28 d)30例,手术年龄4～28(15.00±6.56)d;晚期组(>28 d)32例,手术年龄29～186(58.00±30.54)d。回顾性分析各组术后围术期并发症、早期死亡、中期死亡及再次手术干预等情况。结果二组术后低心排、肺动脉狭窄、心律失常、膈肌麻痹、呼吸道异常、肾衰竭等并发症发生率差异无统计学意义。早期组早期死亡5例,其中死于低心排综合征3例,死于肾衰竭和心脏骤停各1例;晚期组早期死亡1例,死亡原因为低心排综合征。二组早期病死率分别为16.7%(5/30例)和3.1%(1/32例),其差异无统计学意义(P=0.200),二组的主要早期死亡原因均为术后低心排综合征。随访56例出院患儿,随访率91.1%(51/56例),随访时间中位数为35个月(13～71个月)。早期组无需再次干预病例,晚期组2例因术后肺动脉狭窄需再次手术干预,二组比较差异无统计学意义(P=1.000)。早期组无中期死亡,晚期组中期病死率为6.5%(2/31例),二组比较差异无统计学意义(P=1.000)。结论 TGA/VSD患儿术后早期及中期预后好。手术年龄不是TGA/VSD手术时机的决定性因素,术后低心排综合征是TGA/VSD的主要早期死亡原因,术前充分评估,改善术前状态有利于选择良好的手术时机。
Objective To evaluate the effect of ASO timing on prognosis of children with complete aortic transposition of ventricular septal defect (TGA / VSD). Methods Sixty-two children with TGA / VSD who underwent ASO in our hospital from January 2005 to December 2009 were divided into three groups according to age: 30 cases (≤28 days), the age of operation was 4-28 (15.00 ± 6.56) ) d; 32 patients in the advanced group (> 28 d), the operative age ranged from 29 to 186 (58.00 ± 30.54) d. The perioperative complications, early death, mid-term mortality and re-operative intervention were retrospectively analyzed. Results There was no significant difference in the incidence of postoperative complications such as low cardiac output, pulmonary stenosis, arrhythmia, diaphragmatic paralysis, respiratory abnormalities and renal failure. Early death in early group 5 cases, of which died of low cardiac output syndrome in 3 cases, died of renal failure and cardiac arrest in 1 case; the early group died in 1 case, the cause of death was low cardiac output syndrome. The early mortality rates in two groups were 16.7% (5/30 cases) and 3.1% (1/32 cases), respectively, with no significant difference (P = 0.200). The main causes of early death in both groups were postoperative low cardiac arrest Row syndrome. A total of 56 patients were discharged from hospital. The follow-up rate was 91.1% (51/56 cases). The median follow-up time was 35 months (range, 13-71 months). In the early group, there was no need to intervene again. Two patients in the advanced group needed further surgical intervention for pulmonary stenosis. There was no significant difference between the two groups (P = 1.000). There was no interim mortality in the early group, and the metaphase mortality in the late group was 6.5% (2/31). There was no significant difference between the two groups (P = 1.000). Conclusion The prognosis of TGA / VSD patients in early and middle stage is good. Surgical age is not the decisive factor in the timing of TGA / VSD surgery. Postoperative low cardiac output syndrome is the major cause of early death of TGA / VSD. Preoperative evaluation and improvement of preoperative status are helpful to choose a good timing of surgery.