Gong Hainan,Zhang Rufang,Chen Xiaolong,et al.Analysis of factors influencing reintervention after surgical repair of aortic arch anomalies in children[J].Journal of Clinical Pediatric Surgery,2025,(10):946-951.[doi:10.3760/cma.j.cn101785-202405017-008]
儿童主动脉弓部畸形手术后再干预的影响因素分析
- Title:
- Analysis of factors influencing reintervention after surgical repair of aortic arch anomalies in children
- Keywords:
- Aortic Coarctation; Interrupted Aortic Arch; Cardiac Surgical Procedures; Reoperation; Angioplasty; Balloon; Risk Factors; Child
- 摘要:
- 目的 探讨儿童主动脉弓部畸形手术后再干预的影响因素。方法 本研究为回顾性病例对照研究,以2009年1月至2020年12月上海市儿童医院心胸外科收治的128例主动脉弓部畸形手术患儿为研究对象,根据术后是否再次接受外科手术或行介入球囊扩张治疗进行分组,将再次接受外科手术或行介入球囊扩张术的患儿归入再干预组,其余归入非再干预组。收集两组患儿性别、年龄、体重、诊断、术前使用呼吸机、合并心脏相关综合征、合并主动脉弓发育不良、术中手术方式、术后并发症、术后再次接受其他心脏相关手术以及术后高血压等信息,分析主动脉弓部畸形手术后再干预的影响因素。结果 128例患儿中位手术年龄 2个月(范围:1天至168个月),治愈122例,其中接受再干预15例(15/122,12.29%)、未再干预107例;术后发生再狭窄32例(32/122,26.2%)。术后30 d内死亡6例(6/128,4.69%)。单因素分析发现,非再干预组和再干预组患儿体重[体重≤4.5 kg人数占比为(48/107,44.9%)比(11/15,73.3%);大于4.5 kg人数占比为(59/107,55.1%比4/15,26.7%)]、术前使用呼吸机(23/107,21.5%比8/15,53.3%)、合并主动脉发育不良(26/107,24.3%比9/15,60.0%)、手术方式[端端/端侧 (26/107,24.3%比13/15,86.7%);扩大端端/端侧 (83/107,77.6%比2/15,13.3%)]以及术后高血压(4/107,3.7%比3/15,20.0%)是术后再干预的相关因素(P＜0.05)。多因素Cox比例风险回归分析发现,术中采用端端/端侧吻合方式明显增加主动脉弓部畸形手术后再干预率。手术方式(OR=0.092,95%CI:0.02~0.421)是患儿再干预的独立影响因素(P＜0.05)。结论 主动脉弓部畸形根治术的端端/端侧吻合方式是患儿术后再干预的独立危险因素,术中采用扩大的端端/端侧吻合方式可以明显降低主动脉弓部畸形手术后再干预率。
- Abstract:
- Objective To investigate the factors influencing the need for reintervention after surgical repair of aortic arch anomalies in children. Methods A total of 128 children operated for aortic arch anomalies in the Department of Cardiothoracic Surgery at Shanghai Children’s Hospital from January 2009 to December 2020 were retrospectively analyzed.Patients were divided into two groups based on whether they underwent a second surgery or interventional balloon angioplasty postoperatively.Those who received either of these were placed in the reintervention group; the rest were categorized as the non-reintervention group.Data collected included gender,age,weight,diagnosis,preoperative ventilator use,associated cardiac syndromes,aortic arch hypoplasia,surgical technique,postoperative complications,subsequent cardiac surgeries,and postoperative hypertension.Statistical analyses were performed to identify factors associated with reintervention. Results The median age at surgery was 2 months (range:1 day to 168 months).Among 128 children,122 were cured. Fifteen patients(15/122,12.29%) required reintervention,while 107 did not.Postoperative restenosis occurred in 32 cases (32/122,26.2%).There were 6 postoperative deaths within 30 days (6/128,4.69%).Univariate analysis showed that lower body weight [≤4.5 kg (48/107,44.9%) vs.(11/15,73.3%); >4.5 kg (59/107,55.1%) vs.(4/15,26.7%)],preoperative ventilator use (23/107,21.5% vs.8/15,53.3%),aortic arch hypoplasia (26/107,24.3% vs.9/15,60.0%),surgical technique [end-to-end or end-to-side anastomosis:(26/107,24.3%) vs.(13/15,86.7%); extended end-to-end or end-to-side anastomosis:(83/107,77.6%)vs.(2/15,13.3%)],and postoperative hypertension (4/107,3.7% vs.3/15,20.0%) were significantly associated with reintervention (P＜0.05).Multivariate Cox proportional hazards regression analysis indicated that the used of end-to-end or end-to-side anastomosis significantly increased the risk of reintervention after surgery.Surgical technique was identified as an independent factor affecting reintervention (OR=0.092,95%CI:0.02-0.421,P＜0.05). Conclusions The surgical technique used during the initial repair of aortic arch anomalies is an independent risk factor for postoperative reintervention in children.Use of an extended end-to-end or end-to-side anastomosis significantly reduces the risk of reintervention.
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备注/Memo
收稿日期:2024-5-8。
基金项目:上海市医学引导类科技支撑项目(17411969000)
通讯作者:李小兵,Email:cddrlxb@163.com