婴幼儿法洛四联症的外科治疗

目的 总结婴幼儿法洛四联症(TOF)根治术经验.方法 182例婴幼儿法洛四联症中男104例,女78例;年龄4～36个月,平均(10.0±3.2)个月;体重5.1～12.0 kg,平均(6.7±1.4)kg.合并动脉导管未闭(PDA)25例,卵圆孔未闭40例,继发孔型房间隔缺损(ASD)18例,残存左上腔静脉8例.均行根治术,其中单纯右心室流出道(RVOT)心包补片32例,跨瓣环心包补片150例,其中加宽至左、右肺动脉44例.全组均使用膜肺、全血浆预充并采用改良超滤技术.合并畸形均同期处理.结果 治愈177例,治愈率97.2%;手术死亡5例,病死率2.8%.合并低心排出量综合征3例,肺部严重感染2例.160例术后随访2～85个月,无死亡.8例残余微量分流,生长发育正常,无不适.结论 婴幼儿TOF早期行根治手术有利于全身重要器官的发育,避免长期慢性缺氧引起不可逆损害.纠正畸形、避免发生室间隔残余漏和残余右室流出道狭窄或过度扩大右室流出道,是手术成功的关键.良好的麻醉、体外循环技术及术后管理非常重要.

Surgical treatment of tetralogy of Fallot in infants

Objective To summarize the experience of surgical treatment of TOF(tetralogy of Fallot) in 182 infants. 182 infants,104 male and 78 female aged from 4 months to 36 months [average (10.0±3.2) months] ,weighed from 5.1 to 12.0 kg[average(6.7±1.4) kg] , were analysed. There were simple stenosis of infundibular portion in right ventricular outflow tract in 32 cases, stenosis of infundibulum and main pulmonary trunk in 106, and infundibulum, main pulmonary trunk and left or right pulmonary artery stensis in 44. All cases received conrrective surgery of TOF. Autologous pericardial conduit was used to broaden right ventricular outflow tract. Other anomalies wese corrected. Results Thete were 5 operative deaths with the mortality of 2.75%. The causes of death were serious low cardiac output syndrome in 3 cases and acute respiratory distress in 2. 177 infants were followed up from 2 months to 85 months. No late death occurred. All cases were satisfactory, 8 trivial residual shunt. Conclusion Total surgical correction is advantageous to the infants with TOF. The long-term results were satisfactary. Setisfactory anesthesia and bypess technique attribute to the success of surgical treatment of TOF in infants.