成人法洛四联症的外科治疗

Surgical treatment of adult patients with tetralogy of fallot

目的：总结成人法洛四联症（TOF）根治术外科治疗经验。方法：从1998年10月-2005年10月，对13例成人法洛四联症实施根治手术，全组患者均有右室流出道狭窄，8例伴肺动脉瓣狭窄，1例肺动脉瓣、瓣环和主肺动脉多处狭窄，室缺用涤纶片修补，使用涤纶片和自体心包片组成的复合片加宽流出道。8例行跨环补片，4例单纯加宽右室流出道，1例加宽流出道和主肺动脉。结果：全组无死亡病例，术后合并严重低心排8例，急性肾功能衰竭1例。随访4～80个月，无远期死亡。结论：成人法洛四联症术后易出现严重并发症，加强围术期管理，成人TOF患者亦可获得满意疗效。

Objective：To summerize the experience of total correction for adult patients with tetralogy of fallot （TOF）. Methods ：From October 1998 to October 2005,13 adult patients with tetralogy of fallot underwent total correction. Each patient had stenosis of the right ventricular outflow tract （ROVT）. Among them, 8 patients with pulmonary valvular stenosis, 1 patient with mutiple stenosis of pulmonary valve,ring and trunk. The ventricular septal defects were closed with dacron patch in all cases. The complex patch with dacron and autogeneic pericardium was used to enlarge ROVT. 8 cases required tuansannular patch, 1 case enlarged main pulmonary artery trunk and ROVT, 4 cases enlarged ROVT only. Results：No perioperative death. 8 cases with severe low cardiac output syndrome, 1 case with acute renal failure. No late death was encountered during the follow-up period （range 4 - 80 months）. Conclusion ：The adult TOF patients were susceptible to severe post-operative complications after total correction treatment. The perioperative management should be enhanced. The result is satisfactory.