Chen Yichu,Pi Mingan.Comparison of two methods in the treatment of pulmonary atresia with ventricular septal defect[J].Journal of Clinical Pediatric Surgery,,18():492-497.[doi:10.3969/j.issn.1671-6353.2019.06.011]
Comparison of two methods in the treatment of pulmonary atresia with ventricular septal defect
- Keywords:
- Pulmonary Atresia/CO; Pulmonary Atresia/SU; Heart Septal Defects; Ventricular/SU; Treatment Outcome
- CLC:
- R726.2;R543.2
- Abstract:
- Objective To assessed the value of palliative right ventricular-pulmonary artery (RV-PA) shunt in staged surgical management of pulmonary atresia with ventricular septal defect. Methods We retrospectively analyzed the clinical data of 26 pulmonary atresia with ventricular septal defect (PA/VSD) patients undergoing Blalock-Taussig shunt (BTS) or RV-PA connection from January 2012 to June 2017.According to different surgical procedures,they were divided into two groups.In BTS group,there were 5 boys and 4 girls aged from 3 to 60 months.In RV-PA connection group,there were 11 boys and 6 girls aged from 1 to 72 months.Early clinical outcomes including mechanical ventilation time,length of intensive care unit (ICU) stay,improvement of oxygen saturation (SO2),incidence of serious complications,radical curative rate and mortality were compared.Results The improvement of SO2 was markedly higher in RV-PA connection group than that in BTS group[(33.1±6.9)% vs.(25.4±4.6)%](t=-3.357,P=0.008).The difference had statistical significance; The postoperative stay duration of ICU was in BTS and RV-PA connection groups respectively[(3.1±1.5) vs.(4.0±2.6) days](t=2.815,P<0.01).The difference had statistical significance; The mechanical ventilation time was[(27.10±18.60) vs.(34.30±16.15) hours](t=-1.744,P=0.417).The difference had no statistical significance; The postoperative pulmonary effusion was 11.11%(1/9) and 23.53%(4/17) respectively (χ2=0.584,P=0.445).The difference had statistical significance.Cardiac color ultrasound or computed tomography (CT) was performed postoperatively for assessing the development status of cardiac functions and pulmonary vasculature every 6 months.During a follow-up period of 6-60 months,the change of Nakata index was markedly higher in RV-PA connection group than that in BTS group[(67.62±26.74) vs.(56.21±14.37)](t=-3.860,P=0.008).The difference had statistical significance; The radical surgical time interval was markedly shorter in RV-PA connection group than that in BTS group[(15.10±3.22) vs.(18.56±5.42) months](t=3.100,P=0.015).The difference had statistical significance.During follow-ups,the surgical curative rate was 47.06% in RV-PA connection group and 33.33% in BTS group (χ2=0.454,P=0.500).The difference had no statistical significance.One case of early in-hospital mortality occurred in BTS group while RV-PA connection group had no early in-hospital mortality. Conclusion RV-PA connection is better than BTS for PA/VSD patients including greater SO2 improvement and more stable hemodynamics,except for pulmonary effusion.And RV-PA connection in PA/VSD patients requires individualized treatment.
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Memo
收稿日期:2018-03-12。
基金项目:武汉市卫生健康委员会医疗卫生科研项（编号：WX14C54）
通讯作者:皮名安,Email:18672352752@163.com