一期和分期手术矫治小儿法洛四联症的效果  

The analysis of results in the young children with tetralogy of Fallot： one-stage versus staged repair

作　　者：方敏华[1] 王辉山[1] 汪曾炜[1] 王镇龙[1] 张春振[1] 李波[1] 

机构地区：[1]沈阳军区总医院心血管外科,沈阳110840

出　　处：《中华胸心血管外科杂志》2017年第5期267-270,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的 比较法洛四联症（TOF）一期和分期矫治手术的手术技术和早、中期效果.方法 2009年1月至2013年12月共完成459例5岁以下的TOF矫治手术,其中一期矫治手术416例（组Ⅰ）,分期矫治手术43例（组Ⅱ）;男245例,女214例;行矫治手术年龄4～60个月,平均27.8个月,姑息手术年龄3～40个月,平均15.4月.比较两组患儿围手术期和随访期间性别、年龄、体质量、术前临床症状、McGoon比值、肺动脉指数（PAI）、肺动脉环Z值、体外循环时间、主动脉阻断时间、室间隔缺损的修复方式、右心室流出道处理方式、术后右心室/左心室压比值、术后跨瓣压差、术后死亡、严重低心排综合征、低氧血症、呼吸机辅助时间、ICU时间、随访时间、随访期间左心室射血分数（LVEF）、右心室心肌作功指数（MPI）、三尖瓣环收缩期移位、肺动脉瓣反流（PR）等23个.结果 组Ⅱ患者矫治手术时的年龄[（19.1±16.4）个月对（21.1±11.2）个月,P＜0.05）]、体质量[（19.1 ±16.4） kg对（21.1±11.2） kg,P＜0.01）]、肺动脉环Z值（-3.69 ±2.36对-2.50±1.95,P＜0.01）明显小于组Ⅰ.组Ⅱ患者术中经右心室切口修复VSD的比率（63.0％对17.2％,P＜0.01）和采用跨肺动脉瓣环补片加宽的比率（95.3％对53.5％,P＜0.01）明显高于组Ⅰ.两组间术后死亡比例、并发症发生率,呼吸机辅助时间和ICU滞留时间差异无统计学意义.随访12～ 52个月,两组患者LVEF、三尖瓣环收缩期移位和右心室MPI差异无统计学意义,组Ⅱ患者肺动脉瓣重度反流比率明显大于组Ⅰ（47.6％对32.1％,P＜0.01）.结论 一期和分期矫治婴幼儿TOF的早中期效果均满意的.对于肺血管发育不良的患者,分期矫治手术可以降低死亡比例,减少术后严重并发症,但也影响二期矫治手术的方式,影响术后远期的肺动脉反流情况.Objective The study aimed to evaluate the short and middle term results in the patients with tetralogy of Fallot（TOF） after one-stage repair and staged repair.Methods A total of 459 TOF younger children less than five-year-old between January 2009 and December 2013 had received surgical repair,including 416 patients by one-stage repair（group Ⅰ）and 43 patients by staged repair（group Ⅱ）.Among them,245 were male and 214 were female.The average repair surgical age was 27.8 ranged from 4 to 60 months,average palliation age was 15.4 ranged from 3 to 40 months.23 perioperative and follow-up parameters were assessed including sex,age,weight,preoperative clinic symptom,ratio of McGoon,pulmonary artery index,Z score of pulmonary annulus,cardiopulmonary bypass time,aortic cross-clamping time,type of VSD repair,type of RVOT procedure,Peak RV/LV pressure radio,RV-PA pressure grade,mortality,severely low cardiac output syndrome,hypoxemia,extubation time,ICU time,fellow-up time,left ventricular eject faction,RV index of myocardial performance （MPI）,tricuspid annular plane systolic excursion（TAPSE） and pulmonary regurgitation.Results Compared with group Ⅰ,age and weight were significantly lower in patients in group Ⅱ[（19.1 ± 16.4） months vs.（21.1 ± 11.2） months,P ＜ 0.05） and（19.1 ±16.4） kgvs.（21.1 ±11.2） kg,P ＜0.01].The Z score of pulmonary annulus of patients in group Ⅱ were significantly less than those in group Ⅰ （-3.69 ± 2.36 vs.-2.50 ± 1.95,P ＜ 0.01）.The ratio of repairing VSD by RV incision and using TAP in patient of group Ⅱ were significantly more than those in group（27/43 vs.71/413,P ＜0.01）,（41/43 vs.221/413,P ＜0.01）.There was no difference of mortality,complication,extubation time and ICU time bewteen two groups.All patients followed up 12-52 months,there was no difference of LVEF,MPI and TAPSE between two groups.However,the severity of pulmonary regurgitation in patients of group Ⅱ was significant more than those of group Ⅰ （47.6％

关 键 词：法乐氏四联症 心脏外科手术 

分 类 号：R726.5[医药卫生—儿科]