法洛四联症根治术右室流出道疏通程度与近中期预后关系

The Relationship between Right Ventricular Outflow Tract Dredging Degree and Short-to-Mid-Term Results in Children with Repaired Tetralogy of Fallot

摘要: 目的：分析法洛四联症根治术患儿的右室流出道疏通程度与近中期预后的关系。方法：回顾性分析2016年1月至2020年12月重庆医科大学附属儿童医院行法洛四联症根治术患儿的临床特点，统计并分析法洛四联症根治术后发生右室流出道再狭窄、低心排综合征、中重度肺动脉反流(Pulmonary Regurgitation, PR)与右室流出道(Right Ventricular Outflow Tract, RVOT)疏通程度的关系。结果：研究共纳入93例患儿，其中男61例、女32例，年龄(14.8 ± 10.0)个月，体重(9.2 ± 2.2) kg，术后发生右室流出道再狭窄3例、低心排综合征28例、中重度PR 11例，根据是否发生右室流出道再狭窄将患儿分为狭窄组和非狭窄组，再狭窄组的RVOT疏通程度小于非狭窄组(67.5% ± 16.3% vs 31.8% ± 16.4%, P < 0.001)。根据是否发生低心排综合征将患儿分为低心排综合征组和未发生低心排综合征组，两者RVOT疏通程度差异无统计学意义(67.23% ± 17.02% vs 64.26% ± 18.35%, P = 0.453)。根据是否生中重度以上PR将患儿分为中重度PR组与非中重度PR组，两者RVOT疏通程度差异无统计学意义(66.5%±17% vs 65.1% ± 21.1%, P = 0.803)。结论：TOF根治术右室流出道疏通程度越大，患者近中期越不易发生RVOT再狭窄。本中心常规手术后右室流出道疏通程度在60%左右，患者在近中期随访出现中重度肺动脉反流、低心排综合征的频率较低，但远期结局需进一步随访研究。

Abstract: Objective: To analyze the relationship between right ventricular outflow tract dredging degree and short-to-mid-term results in children with TOF. Methods: A retrospective analysis was made on the clinical characteristics of children undergoing radical operation for tetralogy of Fallot in Children’s Hospital Affiliated to Chongqing Medical University from January 2016 to December 2020. The relationship between right ventricular outflow tract restenosis, low cardiac output syndrome, moderate or severe PR and right ventricular outflow tract dredging degree after radical operation for tetralogy of Fallot was statistically analyzed. Results: A total of 93 children were included in the study, including 61 males and 32 females, with an average age of 14.8 ± 10.0 years and average weight of 9.2 ± 2.2 kg. There were 3 cases of right ventricular outflow tract restenosis, 28 cases of low cardiac output syndrome and 11 cases of moderate or severe PR after operation. The children were divided into stenosis group and non-stenosis group according to the occurrence of right ventricular outflow tract stenosis. The degree of RVOT recanalization in restenosis group was lower than that in non-stenosis group (67.5% ± 16.3% vs 31.8% ± 16.4%, P < 0.001). According to the occurrence of low cardiac output syndrome, the children were divided into low cardiac output syndrome group and non-low cardiac output syndrome group. There was no significant difference in the degree of RVOT patency between the two groups (67.23% ± 17.02% vs 64.26% ± 18.35%, P = 0.453). The children were divided into moderate or severe PR group and non-moderate to severe PR group according to whether they had moderate or severe RVOT. There was no significant difference in the degree of RVOT dredging between the two groups (66.5% ± 17% vs 65.1% ± 21.1%, P = 0.803). Conclusion: The greater the recanalization degree of the right ventricular outflow tract after TOF operation is, the less likely the patients to develop RVOT restenosis in the short-to-medium term are. The degree of dredging of the right ventricular outflow tract after routine surgery in our center is about 60%. The frequency of moderate-to-severe pulmonary regurgitation and low cardiac output syndrome is low in the short-to-medium term follow-up, but the long-term outcome needs further study.