法洛四联症合并肺动脉闭锁的外科治疗  

Surgical treatment of tetralogy of Fallot with pulmonary atresia

作　　者：李刚[1] 姬尚义[1] 计乐群[1] 谭敏[1] 王成林[2] 

机构地区：[1]深圳市孙逸仙心血管医院心脏外科,广东省深圳518020 [2]北京大学深圳医院影像中心

出　　处：《中国基层医药》2006年第1期5-6,共2页Chinese Journal of Primary Medicine and Pharmacy

基　　金：吴阶平医学基金临床科研资助项目(2005-86-F)

摘　　要：目的总结法洛四联症合并肺动脉闭锁(TOE-PA)的外科治疗经验,探讨其临床分型、手术时机、手术方法及适应证。方法12例TOE-PA患者接受心内矫治手术,其中男7例,女5例;年龄11d至28岁,其中新生儿1例、婴幼儿7例、儿童3例、成人1例;Ⅰ型5例,Ⅱ型6例,Ⅲ型1例。其中3例为急诊手术,Ⅰ、Ⅱ型11例在全身麻醉中度低温体外循环下行一期根治手术,Ⅲ型1例行姑息手术。结果术后早期死亡2例,均为Ⅱ型患者,死因为严重低心排血量综合征1例、灌注肺继发多脏器功能衰竭1例。长期随访10例,随访5个月至9年,NYHA心功能Ⅰ级或Ⅱ级。结论TOE-PA经明确诊断应尽快手术,准确评估患者肺动脉发育情况以选择合理术式是提高疗效和降低死亡率的关键。Objective To sum up the experiences of surgical treatment of tetralogy of Fallot with pulmonary atresia（TOF-PA） and to explore the indication, surgical technique and optimal time, Methods 12 patients with TOF-PA underwent surgical treatment. There were 7 males and 5 females including 1 neonate,7 infants, 3 children and 1 adult,The age ranged from 11 days to 28 years, 5 patients were in type Ⅰ TOF-PA,type Ⅱ 8, type Ⅲ 1. Through a standard median stenotomy incision,all patients were operated on under moderate hypothemia and cardiopulmonary bypass. 10 patients of type Ⅰ , Ⅱ underwent one-stage radical operation. 1 patient of type Ⅲ received palliative operation. Results Early mortality was 16.7 % （2 patients）. The causes of death were severe low cardiac output and multiorgan function failure. There were no late deaths. Postoperative heart function（NYHA） was class Ⅰ or Ⅱ in 10 patients. Conclusions An early operation on patients with TOF^PA can be accomplished with satisfactory outcomes. It is feasible to evaluate indications of operation and choose radical or palliative procedures by consideration of PAI.

关 键 词：法乐四联症 肺动脉瓣闭锁 心脏外科手术 外科治疗 临床分型 

分 类 号：R654.2[医药卫生—外科学]