法洛四联症的外科治疗

Surgical treatment of 143 consecutive cases of tetralogy of Fallot

目的 总结连续 14 3例法洛四联症 (TOF)根治术的手术治疗经验。方法 14 3例法洛四联症患者 ,平均(10 .1± 6 .7)岁 ,合并肺总动脉闭锁 1例、房间隔缺损 (ASD)及卵圆孔未闭 (PFO) 2 8例、动脉导管未闭 (PDA) 9例、永存左上腔静脉 (PLSVC) 4例。所有患者均施行根治术 ,用涤纶补片修补室间隔缺损 (VSD) ,其中 133例经右心房切口修补 ,10例经右心室流出道 (RVOT)切口修补。用自体心包片行右心室流出道及肺动脉扩大。结果 14 0例治愈出院 ,手术死亡 3例 ,手术死亡率为 2 .1%。结论 法洛四联症根治术成功的关键在于右心功能的保护 ,彻底解除右心室流出道及肺动脉的梗阻 ,加强手术后的管理等。

Objective To present the experience in improving the surgical procedures for total correction of tetralogy of Fallot (TOF) in 143 patients.?Methods The 143 patients with mean age of 10.1 years were subjected to surgical repair of their TOF. The associated cardiac anomalies included atresia of main pulmonary atery in 1 case, atrial septal defect and patent foramen ovale in 28 cases,persistent left superior vena cava in 4 cases and patent ductus arteriosus in 9 cases. Total correction was made on all of the patients.The ventricular septal defect (VSD) was closed with dacron patch, through the right atrium in 133 cases and through the right ventricular outflow tract in 10 cases.?Results The operative mortality rate was 2.1% (3/143).?Conclusion Protection of the function of right heart, total relief of obstruction of right ventricular outflow tract and distal pulmonary arteries, and postoperative care as well, all are important factors influencing the surgical outcome.