成人法乐氏四联症的外科治疗

The surgical treatment of tetralogy of Fallot in adults

目的 总结成人法乐氏四联症外科手术治疗的经验。 方法 从1996年10月至2003年12月对82例18周岁以上成人法乐氏四联症实施根治手术,最大年龄48岁。所有病例均经右室流出道切口完成疏通及室缺修补,室缺全部使用涤纶片修补,27例行跨环补片术,53例单纯补片加宽流出道,1例补片分别加宽主肺动脉和流出道,另有1例直接缝合流出道。 结果住院死亡1例,死亡率为1.2％。16例发生了并发症,包括因肺部感染二次气管插管1例,二次开胸止血6例,残余分流7例(均≤5mm),右室流出道残留梗阻2例(压差>60mmHg)。结论成人法乐氏四联症的根治手术可取得满意的临床结果。

Objective To summarize the experience of total correction for tetralogy of Fallot in adults. Methods 82 patients with tetralogy of Fallot undement total correction. Among them there were 40 males and 42 females ranging in age from 18 to 48(26.2 ±1.0) years.The ventricular septal defects were closed with Dacron patch in all patients. 27 patients required transan-nular patch, 1 patient needs enlargemenl in main pulmonary artery and right ventricular outflow respectively. An effierent tract in one case was sutured direct. Results Nosocomial death was in one case,with a mortality of 1 .2% . 16 patients suffered from compli-cations,including reintubation(n= 1),reexploration for postoperative hemorrhage (n = 6) ,residual shunt(n = 7),residual stenosis (n = 2). Conclusion Good outcome of total correction of tetralogy of Fallot in adults can be achieved.