法洛四联症外科治疗72例疗效分析

目的总结法洛四联症外科治疗的经验。方法在全麻体外循环下行法洛四联症矫治术72例,均采用右室流出道纵切口跨瓣环补片修补。结果心肺转流时间平均（88.5±18.3）min,主动脉阻断时间平均（43.6±15.5）min。术后出现低心排综合征2例（2.8%）,灌注肺4例（5.6%）,胸腔积液4例（5.6%）,肺不张7例（9.7%）,真菌感染2例（2.8%）,二次开胸止血2例（2.8%）。死亡5例,包括：低心排2例,灌注肺1例,心衰2例。术后平均随访（22.3±14.6）个月,患儿紫绀消失,生长发育良好。结论法洛四联症患儿应尽早手术治疗。满意的右室流出道疏通,严密的术后监护是提高手术成功率的关键。

Surgical Treatment of Teralogy of Fallot:72 Cases Report

Objective To review the experiences of surgical treatment of tetralogy of Fallot （TOF）. Methods 72 TOF patients received total correction under cardiopulmonary bypass （CPB）. A vertical incision was made into the right ventricular outflow tract, and armulopeasty with transannular patch grafting was performed. Results The mean CPB time was （88.5 ± 18.3） min, and the average aortic clamping duration was （ 43.6 ± 15.5） min. There was low cardiac output syndrome in 2, perfusion lung in 4, pleural effussion in 4, pulmonary atelectasis in 7, and fungous infection in 2. Re-thoracotomy was carried out to hemostasis in 2 （2.8%）. Five patients died, including 2 of low cardiac output syndrome, 1 of perfusion lung, and 2 of heart failure. Within average （22.3 ± 14.6） months follow-up, all patients obtained well growth and development without any symptoms of cyanosis. Conclusions Surgical intervention should be taken earlier for TOF patients. It is the key point to increase the operative success rate of widening the right ventricular outflow tract adequately and ensuring the pest-operative care intensively.