一岁以内法乐四联症外科根治手术

Surgical correction of Tetralogy of Fallot in the first year of life

目的总结91例1岁以内进行法乐四联症(TOF)外科根治手术经验。方法2000年1月～2005年12月,我单位对91例小于1岁的TOF患儿进行Ⅰ期根治手术,手术时平均年龄为(7.92±0.4)个月(17 d～11.8个月);平均体重为(6.98±0.3)kg(1.7～10.2 kg);男63例,占69.2%,女28例,占30.8%;无症状3例,占3.3%,有症状88例,占96.7%,其中,缺氧发作的有23例,占25.3%。术前均经过心脏彩超和心导管及造影或心脏螺旋CT检查确诊。手术均在中到深低温体外循环下进行,93.4%的患儿行跨瓣环补片(TAP)扩大右室流出道,经右室或右房切口修补室间隔缺损,同期完成其他合并畸形的矫治。平均M率(McGoon Index)为1.88。结果总住院病死率为7.7%,平均主动脉阻断时间为55.2 min,体外循环时间为88.2 min,肺动脉瓣反流轻度65例,占71.4%,无Ⅲ度房室传导阻滞,轻度右室流出道梗阻5例。结论早期进行TOF根治手术可以取得良好的手术效果和相对低的手术病死率。

Objective To review our experience of surgical treatment of Tetralogy of Fallot in the first year of life. Methods Between January 2000 and December 2005, we carried out 91 complete repairs of Tetralogy of Fallot in children under 12 months of age. The mean age at the time of repair was 7. 92 ± 0. 4 months （range： 17 days to 11.8 months）. The mean body weight was 6. 98± 0.3kg （range： 1.7-10. 2 kg）. There were 63 boys （69. 2% ） and 28 girls （30. 8 % ）. Eighty-eight patients were symptomatic （severe cyanosis or hypoxic spells）. The diagnoses were made by two-dimensional and Doppler echocardiography and cardiac catheterization or spiral CT. The operations were carried out with moderate to deep hypothermic cardiopulmonary bypass. 93.4% of the children required enlargement of outflow tract of right ventricle with transannular patch. Ventricular septal defect was re- paired through the incision of right ventricle or right atrium. The mean M ratio was 1.88. Results The hospital mortality rate was 7. 7%. The mean aortic clamping time was 55.2minutes and the mean CPB time was 88. 2 minutes. The incidence of mild pulmonary insufficiency was 71.4%. There was no 3% degree atrioventricular block. However, 5 patients suffered from mild obstruction of right ventricular outflow tract. Conclusions Complete repair of Tetralogy of Fallot in the first year of life is effective with relatively lower hospital death rate.