成人法乐四联症的外科治疗

The surgical treatment of tetralogy of fallot in adults

目的总结成人法乐四联症根治术外科治疗经验。方法19．85年11月～2005年5月收治18岁以上成年法四病人115例，手术根治。所有病例均经右室切口疏通右室流出道（RVOT），同时修补室间隔。跨瓣环RVOT补片74例，单纯RVOT补片37例，1例肺动脉与RVOT分别予以补片，5例右室切口直接缝合。结果术后室间隔残余分流7例（直径3～7mm），RVOT残余梗阻3例（〉50mmHg）。10例伴重度低心排。死亡6例，死亡率5．22％。结论根据成人法四特点，合理设计手术方案，成人法乐氏四联症根治可取得良好效果。

Objective To summarize the experience of radical treatment of tetralogy of fallot in adults. Method Between Nov. 1985 and May 2005, 115 patients over 18 years of age with tetralogy of fallot underwent total surgical correction. Longitudinal or oblique right ventriculotomy was used to ensure complete release right ventricular outflow obstruction and complete ventricular septal defect closure. Transannular patches were used in 74 patients, right ventricular outflow tract （RVOT） patches in 37 cases, primary closure of right ventricle in 5 cases, respectively. One patient had separate pulmonary main artery and RVOT enlargement.Results Seven patients had residual septal defect and 3 cases suffered from residual RVOT obstruction. Severe cardiac output syndrome occurred in 10 patients and 6 patients died early postoperatively with the mortality rate of 5.22%. Conclusion By careful surgical management, the treatment of total correction in adult patients may result in good effectiveness.