136例婴幼儿法洛四联症根治术  

Total correction of tetralogy of Fallot in 136 cases of infants less than three years old

作　　者：彭帮田[1] 王平凡[1] 谌启辉[1] 朱汝军[1] 李永武[1] 刘志永[1] 

机构地区：[1]河南省胸科医院心胸外科,郑州450008

出　　处：《中国实用医刊》2008年第3期1-3,共3页Chinese Journal of Practical Medicine

摘　　要：目的分析婴幼儿法洛四联症的手术时机、手术方法及围术期处理的经验，以提高外科治疗效果。方法回顾分析2004年1月至2006年6月期间，经手术治疗的136例婴幼儿法洛四联症的临床资料，其中男74例，女62例，年龄7个月～3岁，小于1岁19例，体重5．5～15.5kg，手术采用胸骨正中切口，83例应用深低温低流量，常规平衡＋改良超滤。单纯右室流出道补片23例，跨肺动脉瓣环补片113例，其中左肺动脉加宽37例。结果全组手术死亡6例，病死率为4．4％。主要死亡原因是低心排3例，肺水肿1例，急性肾功能衰竭1例，纵隔感染1例，其他并发症有肺炎、肺不张、毛细血管渗漏综合征、心律失常等，均经治疗后痊愈。小残余分流7例。残余梗阻2例，压差〉30mmHg（1mmHg=0．133kPa）。随访3个月～2年，7例残余分流自行闭合，2例残余梗阻压差在30mmHg左右，无症状。结论婴幼儿法洛四联症的手术效果满意。围术期的正确处理和心脏畸形的彻底矫治是降低死亡率的关键。早期诊断和早期治疗将成为法洛四联症根治的外科治疗趋势。Objective To analyze the operative time, operative methods and perioperative management of tetralogy of Fallot（TOF） in infants, in order to improve the efficacy. Methods The clinical data of 136 infants less than three years old of TOF from Jan. 2004 to Jun. 2006 were analyzed retrospectively, including 74 boys and 62 girls, aged from 7 months to three years, 19 cases less than one year old, weight from 5.5 - 15.5 kg. 113 cases（83% ） needed transannular patchs, including to enlarge the left pulmonary in 37 pa- tients. Deep hypothermia low flow（DHLF） was used in 83 cases, routine balance ultrafictration and modified ultrafictration in all patients. Results Six cases dead, the mortality was 4.4%. The main causes of death were serious low cardiac output syndrome （3 cases）. The patients have been followed up for 3 months to 2 years. Two cases with remnant obstruction （ 〉 30 mm Hg） had no symptom. Conclusion The results of primary repair of TOF in infants are satisfactory. The key points in discreaing the surgical mortality lie in ： the cardiac deformity is satisfied put right, the reasonable periopreative managements. The diagnosis and operation in TOF at an early date will be admittedly.

关 键 词：法洛四联症 婴幼儿 根治术 

分 类 号：R541.7[医药卫生—心血管疾病] R654.1[医药卫生—内科学]