360例五岁以下小儿法乐四联症根治术报告

Experience of Decreasing the Operative Mortality of Total Correction of Tetralogy of Fallot in 360 Pediatric Patients

目的：本文通过３６０例３个月至５岁小儿法乐四联症的根治术，介绍如何降低手术死亡率的经验。方法：１９９３年１月至１９９５年９月，为３６０例（男２６５例，女９５例）３个月至５岁的患儿行法乐四联症根治术，平均年龄２．７６±１．４９岁，平均体重１１．４５±３．２５（５～１９）ｋｇ。全麻、深低温（鼻温２０℃）、低流量（２０～４０ｍｌ·ｋｇ－１／ｍｉｎ）体外循环下行根治术，包括修补心室间隔缺损，右心室流出道加宽。１３８例（３８．３３％）跨环补片，１０７例至左右肺动脉分叉处或左肺动脉起始部，２６例用液氮保存的同种带瓣升主动脉（１９例取自新生儿，７例取自成人），手术同期纠正其他心内畸形１８７例（５１．９４％）。结果：手术死亡４例（１．１１％），死因为灌注肺２例，心包填塞及呼吸衰竭各１例。结论：尽管手术适应证较宽，但手术死亡率近年明显下降，这主要与术前纠正贫血、畸形纠正满意、心肺保护良好和正确的术后处理有关。

Objective:This study was conducted to describe the experience of decreasing the operative mortality of total correction of tetralogy of Fallot in pediatric patients. Methods:From Jan.1993 to Sept.1995,360 pediatric patients(265 boys and 95 girls),aged 3 months to 5 yrs(mean 2 76±1 49 yrs)with body weights of 5 to 19 kg(mean 11 45±3 25 kg),underwent total correction of tetralogy of Fallot at Fu Wai Hospital.All of the cases were totally corrected under deep hypothermia(20℃)with low flow CPB(20 40 ml·kg -1 /min).The procedures included VSD repair with dacron patch,valvotomy for pulmonary valve stenosis,resection of the hypertrophic right infundibulum and enlargement of the RVOT and pulmonary trunk.In the 138 cases with transannular patching,aortic homograft patch with valve was used in 26(19 were obtained from neonates and 7 from adults),and autogenous pericardial patch in the others.Transannular patching to pulmonary bifurcation or to left pulmonary artery was performed on 107 cases.Associated anomalies found during operation in 187 cases(51 94%)were corrected. Results:There were 4 postoperative deaths(1 11%)from ARDS(2 cases),tamponade(1 case)and respiratory failure(1 case). Conclusion:Although the indications for total correction of tetralogy of Fallot had been extened recently at our hospital,the operative mortality decreased obviously ,it is related to satisfactory correction of the anomalies,good perioperative protection of the heart and lung function,prompt and correct postoperative management.