中心分流术在重症法洛四联症治疗中的应用

Central aorto-pulmonary shunts in the tetralogy of Fallot

目的 评价中心分流术在重症法洛四联症手术治疗中的应用价值。方法 1998年 1月至2 0 0 3年 12月 ,对 2 4例重症法洛四联症病人应用聚四氟乙烯或膨体聚四氟乙烯人工血管行升主动脉到主肺动脉的中心分流手术。其中男 16例 ,女 8例 ;年龄 7个月～ 19岁 ,平均 ( 5 3± 4 6 )岁 ;体重 6 5～4 5 0kg ,平均 ( 16 9± 9 7)kg。结果 全组均获得理想的流量 ,手术前后SaO2 分别为 0 6 7± 0 0 9和0 93± 0 0 4 (P <0 0 1)。手术死亡 2例 ,病死率 8 3%。 14例已行二期根治手术 ,死亡 1例 ( 7 1% ) ,二期根治术与中心分流术时比较 ,肺动脉增长了 6 0 5 % ,左心室增长了 5 7 4 %。结论 中心分流术是改善重症法洛四联症病情可选择的手术方式 。

Objective To evaluate the surgical results of central aorto-pulmonary shunts in the tetralogy of Fallot. Methods Between January 1998 and December 2003, 24 patients with tetralogy of Fallot, 16 males and 8 females, with age from 7 months to 19 years [mean (5.3±4.6) years] and weight from 6.5 kg to 45.0 kg [mean (16.9±9.7)kg], were studied. Central aorto-pulmonary shunts were performed with Teflon artificial blood vessels in 10 cases and varicosity Teflon artificial blood vessels (Gore-Tex) in 14 cases. The diameter of these vessels was 3 mm to 6 mm. Results Ideal pulmonary flow in each patient was obtained. The mean SaO 2 stepped up from 0.67±0.09 to 0.93±0.04 after operation (P<0.01). There were two postoperative deaths (2/24,8.3%). Two-stage radical operations were performed in 14 patients, and one patient died after operation. In two-stage radical operation, the diameter of pulmonary artery increased 60.5% and EDVI increased 57.4% as compared to the first operation. Conclusion Central aorto-pulmonary shunt is effective in improving patient's conditions and is a preparatory measure for a satisfactory staging operation in severe tetralogy of Fallot.