318例法洛四联症的外科治疗

Surgical treatment of tetralogy of Fallot:A report of 318 cases

目的:总结318例法洛四联症(TOF)患者的手术治疗经验。方法:318例TOF根治手术中,90例修补室缺后直接缝合右室切口,52例补片加宽右室流出道;2例用两块心包补片分别加宽主肺动脉和瓣下流出道;行跨肺动脉瓣环补片171例。合并的心脏畸形作相应的矫正。结果:全组手术成功率99.37%,手术死亡率0.63%(2/318)。死亡原因:1例死于术后血肿心包填塞,1例为拔除气管插管后窒息、呼吸骤停。主要并发症14例(4.4%),其中低心排8例,一过性肾衰竭5例,均经治疗好转,1例Ⅲ度房室传导阻滞安装永久起博器。结论:准确掌握手术指征,根据不同病变采取不同术式是手术成功的关键。

Objective： To sum up the therapeutic results of corrective surgery of 164 cases of tetralogy of Fallot （TOF）. Methods： A total of 318 consecutive cases of TOF underwent corrective surgery. The incision of right ventricle was closed directly in 90 cases, in 52 cases only right ventricle outflow tract （RVOT） was widen, RVOT and main pulmonary were enlarged separately with two patch in 2 cases . and transannular patch was implanted in 171 patients. Other anormalies were all corrected. Results： The surgical achievement rate was 99. 37%（316/318）. The cause death was postoperatively bleeding and tamponade in one case. apnoea after extubate in another case. Conelusion： Handling the operation indication and perform surgery with different methods in TOF patients with different pathologic features is the key point of successful operation.