116例婴幼儿法洛四联症外科根治术经验总结

目的总结3岁以内婴幼儿法洛四联症（Tetralogy of Fallot，TOF）外科根治术的临床经验。方法116例年龄小于3岁的法洛四联症患儿，术前经心脏彩超、心电图、x线胸片检查确诊。112例在低温、低流量体外循环下行法洛四联症一期根治术，104例跨肺动脉瓣环，8例未跨瓣环，4例肺动脉发育不良分期手术治疗。用自体心包补片连续缝合室间膈缺损，自体心包补片或牛心包扩大右室流出道。结果体外循环时间65～175min，平均（87．05土15．84）min，主动脉阻断29～139min，平均（56．75士12．84）min，术后呼吸机使用时间24～98h，平均（36士12．8）h，监护室停留时间2～8天，平均（4．05土2．8）天。治愈出院116例，无死亡病例。近期并发症3例，发生率2．6％。随访儿～35个月，患儿恢复良好，紫绀消失，生长发育明显加快。结论婴幼儿行法洛四联症根治术是安全的，改进手术方法及加强围术期管理是提高婴幼儿法洛四联症根治术手术成功率的关键。

Experience on radical surgery of tetralogy of Fallot in 116 cases of infants and children

Objective To summary clinical experience on radical surgery of tetralogy of Fallot in infants and children less than 3 years old. Methods 116 cases younger than 3 years old were diagnosis of tetralogy of Fallot, confirmed by echocardiography, ECG, X-ray examination preoperatively. 112 cases was treated in a low-temperature low-flow cardiopulmonary bypass tetralogy of Fallot one stage radical surgery, among these cases, 104 cases acrossed the pulmonary valve, eight cases did not across valve, four cases with pulmonary hypoplasia using staged surgery. Septal defect was su- tured by autologous pericardial patch, the right ventricular outflow was expanded with autologous pericardium or bovine pericardium. Results Cardiopulmonary bypass time was 65-175 （87.05-t-15.84） min and aortic clamping time was 29-139 （56.75-1-12.84） min. Postoperative ventilator was used 24-98 （365： 12.8） h and was stayed in intensive care unit 2-8 （4. 055：2.8） days. 116 cases were all cured and no deaths, the recent complications in three cases, the incidence was 2.6%. Followed up for 11-35 months, all cases were with a good recovery, cyanosis was disappeared and body growth was significantly accelerated. Conclusion The radical surgery for tetralogy of Fallot is safe, improved surgical techniques and strengthened perioperative management were the key points to improve success rate in tetralogy of Fallot surgical treatment.