Protein-losing enteropathy after the Fontan operation
Protein-losing enteropathy after the Fontan operation
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DOI：
10.1016/s0022-5223(96)70051-x
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发表时间：
1996-09-01
影响因子：
6
通讯作者：
Danielson, GK
中科院分区：
文献类型：
--
作者：
Feldt, RH;Driscoll, DJ;Danielson, GK
Fontan 手术后对患者进行观察，以确定蛋白质丢失性肠病的频率和严重程度。对 1973 年至 1987 年 1 月间进行的 Fontan 手术后存活 30 天的总共 427 名患者进行了分析，迄今为止，427 名患者中的 47 名患者出现了蛋白丢失性肠病。30 天幸存者中，10 年发生蛋白丢失性肠病的累积风险为 13.4%，诊断后 5 年生存率为 46%。与蛋白丢失性肠病的诊断一致，显示全身静脉压升高、心脏指数降低、肺血管阻力增加和心室舒张末压升高。蛋白丢失性肠病的药物治疗仅部分成功。统计分析表明，与蛋白丢失性肠病相关的因素包括心室解剖结构、术前心室舒张末压升高、手术旁路时间延长、住院时间延长和术后肾功能衰竭。本研究建议谨慎考虑Fontan 手术病例的选择是强制性的，某些围手术期因素可能会导致 Fontan 手术的这种严重并发症。
Patients were observed after the Fontan operation to determine the frequency and severity of protein-losing enteropathy. A total of 427 patients who survived for 30 days after the Fontan operation, performed between 1973 and January 1987, were analyzed and, thus far, protein-losing enteropathy has developed in 47 of 427, The cumulative risk for the development of protein-losing enteropathy by 10 years was 13.4% among 30-day survivors, and 5-year survival after the diagnosis was 46%, Hemodynamic studies done coincident with the diagnosis of protein-losing enteropathy have shown increased systemic venous pressure, decreased cardiac index, increased pulmonary vascular resistance, and increased ventricular end-diastolic pressure, Medical management of protein-losing enteropathy was only partially successful, Statistical analysis has shown that factors related to protein-losing enteropathy were ventricular anatomy, increased preoperative ventricular end-diastolic pressure, longer operative bypass time, increased length of hospital stay, and postoperative renal failure, This study suggests that scrupulous selection of cases for the Fontan operation is mandatory and that certain perioperative factors may predispose to this serious complication of the Fontan procedure.