小儿法洛四联症的外科治疗

Surgical treatment of tetralogy of fallot in children

目的：总结51例小儿法洛四联症外科治疗的临床经验。方法：2002年1月～2008年1月，连续行小儿法洛四联症根治术51例，患者平均年龄（6．24±3．35）岁，平均体重（19．88±6．48）kg。结果：全组术后早期死亡2例，死亡率3．9％，死亡原因为低心排综合征和灌注肺。术后并发低心排综合征3例，灌注肺2例，室缺残余分流2例，胸骨感染二开1例，胸腔积液1例。结论：充分解除右室流出道梗阻，合理加宽肺动脉是手术成功的关键。自体心包补片加宽右室流出道及肺动脉，能够有效解决流出道梗阻及肺动脉狭窄，并可预防残余梗阻的发生。合理的转流技术能有效地保护肺功能，减少术后并发症的发生。

Objective To sum up tile clinical experience of 51 cases of tetralogy of fallot （TOF） in children. Method Between Jan 2002 and Jan 2008, 51 children received radical correction of TOF whose mean age was （ 6.24 ± 3.35 ） year, and the mean weight （ 19.88 ±6.48）kg. Results The surgical mortality was 3.9% （2/51）, and the causes of death were serious low cardiac output and perfusion lung. The common postoperative complications were low cardiac output（ 3 cases） , perfusion lung（ 2 cases） , residual shunt of VSD（ 2 cases） ,reoperation by sternal infection（ 1 case） ,pleural effussion（ 1 case）. Conclusion Total relief of obstruction of right ventricular outflow tract and reasonable broadening of pulmonary artery are the key factors of successful operation. Widening right ventricular outflow tract and pulmonary artery with autologous pericardial patch can effectively resolve pulmonary stenosis and obstruction of right ventricular outflow tract in addition to remnant obstruction. Reasonable bypass technique during intraoperation can effectively protect lung function and reduce the occurrence of postoperative complications.