法洛四联症外科根治手术治疗6个月以内患儿54例经验总结

目的总结54例6个月以内婴幼儿行法洛四联症(tetrology of Fallot,TOF)外科根治手术的经验。方法 2006年1月至2012年12月广东省人民医院对54例<6个月的TOF患儿进行一期根治手术,手术时月龄为(4.94±0.40)个月,体质量为(5.98±0.30)kg。其中男34例,占63%;女20例,占37%。无症状患儿4例,占7.4%。有症状患儿50例,占92.3%;其中,缺氧发作的16例,占30%。术前均经过超声心动图和心脏螺旋计算机断层扫描检查确诊,M率为1.76(0.94～3.09)。手术均在中低温体外循环下进行,94.4%患儿行跨瓣环补片扩大右心室流出道,经右心室或右心房切口修补室间隔缺损,同期完成其他合并畸形的矫治。结果总住院病死率为5.6%(3/54),主动脉阻断时间为(58.3±12.2)min,体外循环时间为(87.2±11.6)min。肺动脉瓣轻度反流38例,占70.4%(38/54)。无Ⅲ度房室传导阻滞,轻度右心室流出道梗阻5例。结论 TOF矫治年龄可以前移至在6个月以内进行,并可以获得良好的手术效果和较低的手术病死率。

Experience of surgical management of tetralogy of Fallot in infant less than 6 months

Objectives To summarize the experience of surgical treatment of tetralogy of Fallot （TOF） in infant less than 6 months. Methods From January 2006 to December 2012, we carried out complete repair of TOF for 54 patients whose ages are less than 6 months. They were （4.94±0.4） months old, weighted （5.98±0.3） kg. Among them, 34 patients （63%, 34/54） was males and 20 patients were females （37%, 20/54）. Fifty patients were symptomatic （severe cyanosis or hypoxic spells） and 4 patients were asymptomatic. All patients were diagnosed by two-dimensional and Doppler echocardiography and cardiac spiral computerized tomography before the operation. The mean M ratio was 1.76 （0.94- 3.09）. All the operations were carried out with moderate to deep hypothermic cardiopulmonary bypass. 94.4% of these children needed enlargement of outflow tract of fight ventricle with transannular patch. Ventricular septal defect was repaired through the incision of right ventricle or right atrium, at the same time, the other cardiac defects were repaired. Results Hospital death rate was 5.6%（3/54）. Duration of aortic clamping was （58.3±12.2） min, and duration of cardiopulmonary bypass was （87.2±11.6） min. The number of mild pulmonary insufficiency was 38（70.4%, 38/54）. There was no 3rd degree atrioventricular block and 5 cases of mild obstruction of fight ventricular outflow tract. Conclusions Complete repair of TOF in infant less than 6 months can bring good surgical result and lower hospital death rate.