CAJ | 학술논문

目的探讨儿童右室双出口(DORV)的外科治疗效果.方法自1984年8月至2010年6月共手术治疗118例DORV,其中男62例,女56例,年龄10 d～12岁,平均(3.2±2.6)岁,体重3.0～22.5 kg,平均(9.6±3.7)kg.根据SIS-EACTS数据库分类:VSD型86例,TOF型22例,TGA型3例,VSD远离大动脉型7例.手术方法包括采用单纯心室内隧道修补21例,心室内隧道修补+右室流出道扩大补片84例,其中82例自体心包扩大补片,2例行同种带瓣外管道;Switch术4例,双向格林术6例,Fontan术1例,肺动脉环缩术1例,B-T分流术1例.回顾性分析DORV的手术方法和效果.结果住院死亡9例,病死率7.6%,主要死亡原因为低心排综合症.2004年前手术51例,死亡7例(病死率13.7%),2005年后手术67例,死亡2例(病死率2.9%).存活病例随访2个月～10年,超声心动图检查未见左室流出道梗阻,1例患儿术后2年发现右室流出道残余梗阻,再次手术疏通右室流出道,余患儿效果良好,无晚期死亡病例.结论根据DORV患儿的解剖特点和年龄,制订个体化的手术方案,有助于提高手术成功率.
목적 탐토인동우실쌍출구(DORV)적외과치료효과.방법 자1984년8월지2010년6월공수술치료118례DORV,기중남62례,녀56례,년령10 d～12세,평균(3.2±2.6)세,체중3.0～22.5 kg,평균(9.6±3.7)kg.근거SIS-EACTS수거고분류:VSD형86례,TOF형22례,TGA형3례,VSD원리대동맥형7례.수술방법포괄채용단순심실내수도수보21례,심실내수도수보+우실류출도확대보편84례,기중82례자체심포확대보편,2례행동충대판외관도;Switch술4례,쌍향격림술6례,Fontan술1례,폐동맥배축술1례,B-T분류술1례.회고성분석DORV적수술방법화효과.결과 주원사망9례,병사솔7.6%,주요사망원인위저심배종합증.2004년전수술51례,사망7례(병사솔13.7%),2005년후수술67례,사망2례(병사솔2.9%).존활병례수방2개월～10년,초성심동도검사미견좌실류출도경조,1례환인술후2년발현우실류출도잔여경조,재차수술소통우실류출도,여환인효과량호,무만기사망병례.결론 근거DORV환인적해부특점화년령,제정개체화적수술방안,유조우제고수술성공솔.
Objective To summarize our experience of surgical treatment for double-outlet right ventricle (DORV) in children. Methods From August 1984 to June 2010, 118 patients with DORV underwent surgical repair at this center. Among the 118 patients, 62 were males and 56 were females.Their ages ranged from 10 days to 12 years old (mean age, 3. 2 ± 2. 6). Their weight ranged from 3. 0to 22. 5 kg (mean weight, 9. 6 ± 3. 7 kg). According to the STS-EACTS international nomenclature,86 patients were DORV associated with ventricular septal defect (VSD), 22 were DORV with tetralogy of Fallot (TOF), 3 were DORV with transposition of the greater arteries (TGA), and 7 were DORV with remote VSD. Corrective surgeries included 22 interventricular repairs, 84 interventricular repairs plus right ventricular outflow tract reconstruction (pericardium was used for the reconstruction in 82 cases, and valved extracardiac conduits was used in 2 cases), 4 switch procedures, 6 bidirectional Glenn procedures, 1 Fontan procedure, 1 Pulmonary artery banding procedure, and 1 Blalock-Taussig Shunt procedure. The surgical safety and efficacy were studied by retrospectively analyzing the clinical data of the 118 cases. Results Nine patients died after surgery (7. 6%). The leading cause of death was low cardiac output syndrome. Of the 51 patients underwent corrective surgery before 2004,7 died after surgery (13. 7%). However, only 2 died in the 67 patients who had surgery after 2005(2. 9%). The patients were followed up for 2 months to 10 years. Cardiac ultrasonography didn't show any obstruction of left ventricular outflow tract, but 1 patient developed left ventricular outflow tract obstruction 2 years after surgery and received corrective surgery. No long-term death and other complications were noted. Conclusions Surgical strategy for the children with double-outlet right ventricle should be made based on patients individual anatomic anomalies.