78例成人法洛四联症的外科治疗

Surgical correction of adult TOF in seventy-eight patients

目的深入研究成人法洛四联症的外科治疗特点。方法从1995年1月至2004年6月,对78例16岁以上的成人法洛四联症的患者施行根治术,最大年龄为48岁。全组室间隔缺损除2例为干下型外,其余全为嵴下型,均以Dacron毡片修补,而右室流出道狭窄(包括混合性狭窄)均以补片行扩大成形术,其中46例采用复合牛心包,而另32例则使用自体心包。行单纯右室流出道瓣下成形者41例,行跨瓣成形者37例。结果住院死亡2例,死亡率2.56%。术后主要并发症有低心排综合征15例(19.23%)、心律失常8例(10.25%)、胸液过多需剖胸止血5例(6.41%)、肺部感染3例(3.85%),此外还有严重伤口感染、气管大出血和室间隔缺损残余分流各1例。在2例死亡病例中,1例死于术后严重低心排综合征,另1例死于感染性休克。结论成人法洛四联症的根治术较儿童有其特殊性,如长期缺氧致侧支循环丰富、右心室及流出道的肌束明显肥厚、心内膜组织广泛纤维化等等。了解并掌握其特点,可改进手术方法、提高围术期处理的能力,从而进一步提高手术成功率。

Objective Further study on characteristics of surgical treatment for TOF in adult. Methods 78 adult TOF patients underwent surgical correction were included (1995.1-2004.6). Ages of these patients ranged from 16 to 48 years. Two of ventricular septal defect (VSD) among all these cases belonged to supercrista defect. The others belonged to infracrista defect. All of these VSD were repaired with Dacron patch. The stenoses of right ventricular outlet track (including mixed stenoses) were corrected by widened plasty with patches. 46 among these patches were prosthetic bovine pericardium. The other 32 patches were self- pericardium. Widened with patches of right ventricular outlet track were performed in 41 cases, and crossing the pulmonary valve annulus were 37 cases. Results Two cases died before discharge. The mortality was 2.56%. Main post-operative complications were low cardiac output syndrome (19.23%), arrhythmia (10.25%), massive bleeding, which needed re-operration (6.41%), lung inflection (3.85%). Other post-operative complications included severe incision infection, massive tracheal bleeding, and residual shunt. Among the two died cases, one died of severe low cardiac output syndrome, the other died of septic shock. Conclusion Distinction of TOF in adult from in pediatric including enriched collateral circulation resulted from long term ischemia, obvious hypertrophy of myocardium bundles in right ventricular outlet track, diffused fibrosis in endocardium tissue, et al. Better understanding of these distinctions, modifying procedure, inproving of care of great inportance for further improve of the final result of surgical treatment.