儿童重症法洛四联症行分期手术的临床分析  

Clinical Analysis of Staged Repair for Severe Tetralogy of Fallot in Children

作　　者：胡睿[1] 姜兆磊[1] 刘浩[1] 张俊文[1] 鲍春荣[1] 丁芳宝[1] 梅举[1] 

机构地区：[1]上海交通大学医学院附属新华医院心胸外科,上海200092

出　　处：《中国胸心血管外科临床杂志》2016年第9期880-884,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的回顾性分析儿童重症法洛四联症（tetralogyofFallot，TOF）分期手术治疗的临床疗效，探究儿童TOF的个性化治疗方案。方法回顾性分析新华医院2009年1月至2014年12月期间收治TOF110例患者的临床资料，根据生长发育程度、缺氧程度、肺动脉发育程度（McGoon比值）、左心室容积指数（1eftventricularend—diastolicvolumeindex，LVEDVI）将患儿分为重症TOF组（A组）和轻症TOF组（B组）。A组共23例，均行分期手术，一期行改良肺动脉一锁骨下动脉连接术（modifiedBlalock—Taussig，MBTs），二期行TOF根治术；B组共87例，均行一期TOF根治手术。分析比较两组患儿术前、术后动脉血氧饱和度、McGoon比值、LVEDVI、手术情况及随访情况，总结相关治疗经验。结果A组一期MBTs术后无死亡，两次手术间隔为9（6．3～25．3）个月；与一期MBTs术时相比，二期根治术时的McGoon比值、LVEDVI均有所提高，肺动脉发育和左心室发育均达到了根治手术的标准（P〈0．01）；二期根治术后早期死亡1例，因肺部感染死亡，其余均顺利出院，术后随访结果良好。B组一期根治术后早期死亡3例，无晚期死亡，死亡原因为低心排血量综合征。根治手术时，两组患儿的住院病死率、住院总时间、体外循环时间、主动脉阻断时间、术中使用跨瓣环补片、术后重症监护时间、渗出总量以及气管插管时间差异无统计学意义（P〉O．05）。结论不满足行一期根治手术标准的重症TOF患儿，行分期手术治疗效果可靠。儿童TOF行分期根治手术，可以达到与轻症TOF行一期根治术相似的早、中期疗效，远期效果有待进一步随访观察。Objective To analyze the clinical effects of staged repair for severe tetralogy of Fallot （TOF）, and to investigate a better individual treatment of TOF. Methods We retrospectively analyzed the clinical data of 110 children with TOF in our hospital from January 2009 through December 2014. The patients were divided into a severe TOF group （Group A, n=23） and a mild TOF group （Group B, n=87）. In the group A, all 23 patients underwent staged surgery （modified Blalock-Taussig and radical operation of TOF）. In the Group B, all 87 patients only received a radical operation of TOF. The patients＇ preoperative and postoperative arterial oxygen saturation, McGoon ratio, left ventricular end- diastolic volume index （LVEDVI）, the results of perioperation and follow-up were compared. Results In the group A, there was no death after modified Blalock-Taussig （MBT）. The median interval time between MBTs and radical operation was 9 months （ranged from 6.3 to 25.3 months）. Compared with that before MBTs, the McGoon ratio and LVEDVI were significantly increased at the time of radical operation. And the pulmonary artery development and left ventricle volume reached the standard of radical operation of TOF （P〈0.0 1）. After the radical operation, one patient died for pneumonia in the early postoperation period. In the group B, three patients died for low cardiac output syndrome during perioperation. There was no significant difference between the group A and the group B in in-hospital mortality, length of hospital stay, intensive care unit （ICU） stay, ventilation time, cardiopulmonary bypass time, aortic cross-clamp time, rate of using trans-annular repair path, or drainage of pleural fluid. Condusion Staged repair of severe TOF is safe and effective for children, who are not suitable for one-stage radical operation. Severe TOF received staged repair can achieve the similar outcomes with that of mild TOF underwent one-stage radical operation.

关 键 词：法洛四联症 心脏外科手术 分期根治 体肺分流术 

分 类 号：R726.5[医药卫生—儿科]