成人法洛四联症根治术135例临床分析  

Surgical treatment of adult Tetralogy of Fallot in 135 patients

作　　者：周丹[1] 陶凉[1] 周宏[1] 陈瑾[1] 

机构地区：[1]武汉亚洲心脏病医院心外科,湖北省武汉市430022

出　　处：《中国心血管病研究》2017年第6期498-501,共4页Chinese Journal of Cardiovascular Research

摘　　要：目的 总结成人法洛四联症（TOF）的外科手术治疗经验.方法 回顾性分析2006年1月至2016年8月我院135例成人法洛四联症患者手术治疗的临床资料.所有患者在低温体外循环下行根治术,其中91例采用跨瓣环补片加宽右心室流出道及肺动脉,17例仅行右心室流出道扩大补片,27例疏通流出 道后直接缝合右室切口.结果 住院期间死亡率2.2％（3/135）,死亡原因均为低心排血量综合征.其余并发症包括室缺残余漏2例、一过性Ⅲ度房室传导阻滞4例未安装永久起博器、心包积液2例、胸腔积液5例、肺不张4例、肺部感染2例、肾衰竭2例（行血液滤过治疗后1例恢复1例死亡）.随访128例,平均随访16.6（3-55）个月,心功能Ⅰ级96例（75％）,心功能Ⅱ级32例（25％）.结论 彻底矫正畸形、加强心肌保护、避免发生低心排血量综合征、加强术后管理,成人法洛四联症外科手术可取得良好的疗效.Objective To review the clinical experience in surgical treatment of Tetralogy of Fallot in adult patients.Methods From January 2006 to August 2016,135 adult patients with Tetralogy of Fallot received surgical treatment.The age ranged from 18 to 52 years old.A transannular RVOT patch were constructed in 91 cases,in 17 cases only RVOT was widen,and the incision of RV was closed directely in 27 cases.Results 3 patients died during hospitalization with a hospital mortality of 2.2%.The causes of death were low output syndrome （LOS） and then complicated by multiple organ failure.Main postoperative complications included residual shunt needed reoperation in 2 case,transient A-V block in 4,pericardial effusion in 2,pleural effusion in 5,at-electasis in 4,lung infection in 2,renal failure in 2 （1 died and 1 recovered after hemodialysis）.128 patients were followed up from 3 months to 55 months,average 16.6 months.96 cases were in NYHA class I,32 cases in class Ⅱ.Conclusion By careful surgical management,complete deformity correction,satisfactory myocardial protection and postoperative management,the treatment of total correction in adult patients with TOF may result in satisfactory long-term clinical effect.

关 键 词：法洛四联症 心脏外科 手术 

分 类 号：R654.2[医药卫生—外科学]