6个月以下婴儿法洛四联症的外科治疗

目的探讨小婴儿法洛四联症（TOF）的最佳手术时机,以提高外科手术疗效,降低手术死亡率。方法回顾性分析我科1996年10月至2006年12月收治的108例6个月以下TOF婴儿的临床资料,其中男70例,女38例;年龄9 d~6个月,平均年龄4.70个月。108例患者中行TOF根治术104例,体动脉-肺动脉分流术4例;其中行急诊手术5例。结果手术死亡5例,死亡率4.63%,死于低心排血量综合征3例,肺部感染、左肺发育不全导致急性呼吸窘迫综合征（ARDS）1例,急性坏死性肠炎1例。随访82例,随访时间31.17±40.00个月;失访21例。随访期间无远期死亡,1例患者术后6个月因肺动脉狭窄行二次手术矫治,平均再手术率为0.92%;其余患者心功能（NYHA）Ⅰ~Ⅱ级,超声心动图提示：室间隔无残余分流,右心室流出道和肺动脉瓣无明显狭窄,跨瓣压差小于50mm Hg。结论对6个月以下的小婴儿早期行TOF根治术是可行的,手术死亡率是可以接受的。

Surgical Treatment for Infants Under Six Months with Tetralogy of Fallot

Objective To investigate the optimal timing for surgical treatment of infants less than six months of age with tetralogy of Fallot （TOF）, and to improve surgical results and reduce early mortality. Methods Clinical material of 108 consecutive patients with TOF who were less than six months of age undergoing early surgery from Oct. 1996 to Dec. 2006 were retrospectively reviewed. There were 70 males and females with mean age of 4.70 months （9 d--6 months）. 104 patients underwent complete repair and four patients underwent Blaloek-Taussig （B -T） shunt. Emergency procedures have been performed in 5 patients. Results Five patients （4.63 %） died of low cardiac output syndrome （3 patients）, pulmonary infection and acute respiratory distress syndrome （1 patient）, and acute neerotizing enteritis （1 patient）. 82 patients were followed up, follow-up period was 31. 17 ±40.00 months. 21 patients lost to follow-up. One patient（0.92%） required additional intervention for pulmonary valve stenosis 6 months after operation. Heart functional class（New York Heart Association） recovered to Ⅰ-Ⅱ grading in other patients. Echocardiography shows： no residual ventricular shunt, no stenosis in right ventricular outflow tract and pulmonary valve, pressure difference≤50 mm Hg. No late deaths. Conclusion Early definitive repair of TOF can be performed safely on infants less than six months of age, the results of low mortality is acceptable.