中文摘要：

目的 回顾性分析初次手术中应用sutureless技术治疗婴幼儿完全性肺静脉异位引流（TAPVC）的早、中期效果.方法 2007年7月1日至2012年12月31日,126例行外科矫治术的心上型、心下型和混合型TAPVC患儿（婴）入选,其中sutureless手术方式组54例,传统手术方式组72例,收集术前术后临床资料并随访至2013年4月.结果 Sutureless技术组的体外循环时间和主动脉阻断时间均低于传统手术组（分别为Z=1 296.000、P=0.001和Z=1 181.500、P=0.000）.Sutureless技术组和传统手术组相比,院内死亡比例差异无统计学意义（3.7％对11.1％,x2 =1.414,P=0.234）,术后总死亡比例低（5.6％对23.6％,x2=7.533,P=0.006）,术后肺静脉梗阻发生率低（1.9％对16.7％,x2=7.319,P=0.007）.校正术前肺静脉狭窄、混合型、新生儿以及体质量等因素后,术后死亡与传统手术方式（HR =4.53,95％置信区间1.31～ 15.72,P=0.017）和术后肺静脉梗阻的发生（HR=10.42,95％置信区间1.32～ 82.02,P=0.026）显著相关.结论 对于心上型、心下型及昆合型TAPVC患儿,初次矫治手术采用sutureless技术可以明显缩短体外循环和主动脉阻断时间,降低术后死亡比例和肺静脉梗阻发生率.

英文摘要：

Objective To retrospectively analyze the early and medium-term effect of the primary application of the sutureless repair to infant patients with total anomalous pulmonary venous connection （TAPVC）.Methods One hundred and twenty-six consecutive infants（July 2007 to December 2012） with supracardiac,infracardiac and mixed-type TAPVC were retrospectively reviewed and followed up till April 2013.Survival and postoperative pulmonary venous obstruction （PVO） were compared between the sutureless group （54 cases ; median age 60 days ; body weight 4.2 kg） and the conventional group （72 cases ; median age 30 days; body weight 4.2 kg）.Predictors for death and PVO were identified by an univariate and multivariate analysis using a Cox logistic method.Results No differences were noted on preoperative variables between the groups.The cardiopulmonary bypass time and aortic crossclamp time are much shorter in the sutureless group than the conventional group （83.5 min vs.100.0 min,Z =1 296.000,P =0.001 ; and 43.0 min vs.57.0 min,Z =1181.500,P =0.000,respectively）.Two patients in the sutureless group and eight in the conventional group died in hospital.There was a trend toward lower in-hospital death rate in the suturelss group（3.7 % vs.11.1%,x2 =1.414,P =0.234）.Furthermore,the rate of total death（5.6% vs.23.6%,x2 =7.533,P=0.006） and PVO（1.9 % vs.16.7%,x2 =7.319,P=0.007） is decreased in the sutureless group.Adjusted by the factors of preoperative PVO,mixed-type,neonates and body weight,the conventional surgical technique is significantly related to postoperative death [HR =4.53,95 % CI（1.31,15.72）,P =0.017] and PVO [HR =10.42,95% CI（1.32,82.02）,P =0.026].Conclusion Results Conclusions The primary sutureless repair for the patients with TAPVC appeared to be safe and effective,resulting in improved survival and freedom from PVO and reintervention.