不同手术径路纠治法洛四联症的围术期结果比较

Comparison of Perioperative Results in Different Operative Approaches in Repairing Tetralogy of Fallot

目的比较经右心室(RV)和经右心房-右心室(RA-RV)小切口径路纠治法洛四联症(TOF)的围术期结果,以提高TOF根治术的疗效。方法回顾性分析1998年1月～2007年12月收治的1423例TOF行一期根治手术患者的临床资料,其中经RV径路手术736例,经RA-RV小切口径路手术687例。结果经RV径路手术从1998年的100%下降至2002年的65%,经RA-RV径路手术从2002年的35%增加至2007年的79%;经RA-RV径路手术患者主动脉阻断时间、体外循环时间、平均呼吸机辅助时间和平均住ICU时间均短于经RV径路手术患者(P<0.05);跨瓣环补片比率差异无统计学意义。经RA-RV径路手术患者发生1个和2个器官功能不全少于经RV径路手术患者,大于3个脏器功能不全发生率差异无统计学意义。残余室间隔缺损、残余梗阻、三尖瓣反流、肺动脉反流、心律失常、再手术率和死亡率均低于经RV径路手术患者(P<0.05)。结论经RA-RV径路手术是一种较好的、适合我国TOF患者实际情况的手术方式。

Objective To compare perioperative results between transventricular and transatrial-transventricular approaches in repairing tetralogy of Fallot （TOF）, and to improve the surgical results. Methods The data of 1 423 consecutive patients who underwent complete repair of TOF between January 1998 and December 2007 were reviewed. 736 patients were repaired by the transventricular approach, and 687 patients by the transatrial-transventricular approach. Results Patients repaired by transventricular approach decreased from 100% in 1998 to 65% in 2002, and by transatrial-transventricular approach increased from 35% in 2002 to 79% in 2007. Aortic clamping time, cardiopulmonary bypass （CPB） time, mechanical ventilation time, and intensive care unit （ICU） stay in patients repaired by transatrial-transventricular approach had less than those in patients repaired by transventricular approach. No difference in transvalve patch ratio. There was lower morbidity in patients repaired by transatrial-transventrieular approach in one to two organ systems dysfunction than that in patients repaired by transventricular approach. No difference in three or more organ systems dysfunction between them. Rate of residual ventricular septal defect（VSD）, right ventricule to mean pulmonary artery （MPA） pressure gradient, tricuspid regurgitation, pulmonary artery regurgitation and arrhythmia in patients repaired by transatrial-transventricular approach were less than those in patients repaired by transventrieular approach. Reoperative rate and mortality in patients repaired by transatrial- transventricular approach were less than those in patients repaired by transventricular approach. Conclusion TOF repair by the transatrial- transvenlricular approach fits to the actual conditions in China.