无右心室切口单纯心内修复矫治法洛四联症280例  

Intracardiac repair for 280 cases fallot tetrad without right ventricular incision

作　　者：江毅[1] 吴文森[1] 杨柳山[1] 张赋[1] 范悦[1] 方恒晓[1] 

机构地区：[1]广西中医药大学附属瑞康医院心胸外科,530011

出　　处：《辽宁医学杂志》2013年第1期1-3,共3页Medical Journal of Liaoning

摘　　要：目的总结采用无右心室切口单纯心内修复矫治法洛四联症(TOF)患者的临床经验。方法回顾总结2003年8月至2012年3月我科对280例TOF患者施行无右心室切口单纯心内修复,其中男197例,女83例。年龄4个月至34岁。全部经右房,必要时联合肺动脉路径充分疏通右心室流出道及修补室间隔缺损。结果围术期死亡8例,其中死于灌注肺3例,渗漏综合征5例。呼吸机辅助呼吸时间(15.21±7.64)小时,住ICU时间(35.34±23.80)小时。术后发生残余漏6例,因漏口均<3mm未做处理;肺部感染15例,其中4例为真菌感染。胸腔积液12例,腹腔积液5例,均经药物或相应的治疗后好转。灌注肺二次气管内插管8例,术后二次开胸止血5例,无Ⅲ度房室传导阻滞、无低心排血量综合征和肾功能不全发生。术后随访267例,随访时间3～106个月,所有患者均恢复良好,紫绀消失,恢复正常生活和工作。心功能分级(NYHA)Ⅰ级243例,Ⅱ级24例。术后1～12个月复查超声心动图提示:肺动脉瓣无反流或仅有轻度反流。跨肺动脉瓣压差>30mmHg的52例,>40mmHg的13例。跨肺动脉瓣压差>40mmHg的13例中有9例为肺动脉瓣环狭者。结论对大部分单纯漏斗部狭窄、室间隔缺损为嵴下型患者,采用无右心室切口单纯心内修复方法是可行的,有利于心功能的保护及术后恢复。Objective To summarize the pure right ventricular incision intracardiac repair correction of Tetralogy of Fallot（TOF） in patients with clinical experience,as much as possible to protect the function of right heart.Methods From 2003August to 2012March in our department in 280cases of TOF patients without right ventricular incision for simple intracardiac repair,of which 197cases were male,83were female;age 4months～34years.All of the right atrium,necessary combined pulmonary artery path sufficiently clear right ventricular outflow tract and repair of ventricular septal defect.Results Perioperative death occurred 8cases,3cases died in perfusion lung,5cases died in leakage syndrome.The ventilator assisted breathing time was 15.21±7.64h,ICU 35.34± 23.80 H.The incidence of postoperative residual leakage in 6cases,because the ventage are＆lt;3mm untreated;pulmonary infection in 15cases,including 4cases of fungal infection,pleural effusion 12cases,ascites 5cases,by drugs or after corresponding treatment recovered.Perfusion lung two endotracheal intubation 8cases,postoperative two thoracotomy hemostasis 5cases,noⅢ-AVB,no low cardiac output syndrome and renal dysfunction.Postoperative follow-up of 267patients,follow-up of 3～106months,all patients recovered well,cyanosis disappeared,restore normal life and work,heart function classification（NYHA） Ⅰin 243cases,heart function classificationⅡin 24 cases.After 1～12months ultrasound heartbeat graph tips ： pulmonary valve without reflux or only mild reflux;across the pulmonary valve pressure difference＆gt;30mmHg in 52cases,＆gt;40mmHg in 13cases（the 9cases of pulmonary valve annulus narrowly）.Conclusion The most pure infundibular stenosis,ventricular septal defect underthe ridge type patients,with right ventricular incision for simple intracardiac repair method is feasible,is conducive to heart function and postoperative recovery.

关 键 词：法洛四联症 右心室切口 单纯心内修复 

分 类 号：R654.2[医药卫生—外科学]