婴幼儿法洛四联症1期根治术时机选择

目的:评价婴幼儿法洛四联症(TOF)早期根治术后效果。方法:2002年1月至2006年6月,我科共手术治疗<36个月婴幼儿TOF 87例,年龄(2~36)个月,平均(17.2±5.6)个月:<6个月14例(16.1%)、7~12个月34例(39.1%)、13~36个月39例(44.8%)。比较不同年龄组手术病死率、围手术期处理、术后并发症及随访结果。结果:2例(2.3%)死于术后低心排出量综合征,1例(1.2%)死于术后心律失常。不同年龄组术后并发症差异无统计学意义。术后6个月以下患儿更多需要升压药维持,但术后呼吸机通气时间、ICU停留时间、住院时间差异无统计学意义。回访时间2.0~6.0年,平均(3.5±1.6)年,56例(66.7%)例患儿存在不同程度肺动脉瓣反流,2例(2.3%)残余右心室流出道梗阻,3例(3.4%)室缺残余分流再次手术矫治。结论:对<6个月婴儿TOF一期根治手术病死率和术后并发症低,手术年龄不影响术后效果。

Medium term outcome for infant and little children primary repair in tetralogy of Fallot: indicators for timing of surgery

Objective：To assess the impact of early primary repair on the short and medium term outcome in infants with tetralogy of Fallot（TOF）.Method：Eighty and seven under 36 months of age undergoing correction of isolated TOF were reviewed between January 2002 and June 2006 retrospectively.The mean age of repair was（17.2±5.6） months（range 2-36） of whom 14（16.1%） were less than 6 months old,34（39.1%） were 7-12 months old and 39（44.8% ） were 13-36 months. Outcome data for mortality, post-operative care management, major morbidity and clinical follow-up were analyzed. Result： There were 2 （2.3 % ） early death caused by low cardiac output and 1 （1.2%） death secondary to an apparent arrhythmia. There were no differences in post-operative morbidities attributable to age. The increase in inotrope requirement in patients under 6 months old was significant, but they required the same duration of post-operative ventilation, ICU stay and in-hospital stay. At a mean follow-up of （3.5 ± 1.6） years （range 2.0-6.0）, 56 （66.7 % ） patients had pulmonary regurgitation （PR）. 2 （2.3 % ） patients for residual right ventricular outflow tract obstruction （RVOTO） and 3（3.4% ） patients for residual ventrieular septum defect required reoperation. Conclusion： Early definitive repair of TOF can be performed safely with low morbidity and mortality on patients even under 6 months old. Age at surgery does not appear to affect the medium term outcome.