128例婴幼儿法洛四联症根治手术的临床经验总结

Clinical experiences in radical surgery for tetralogy of Fallot in infancy:a report of 128 cases

目的总结128例婴儿法洛四联症(TOF)根治手术的临床经验,以期指导临床治疗。方法1996年1月-2007年12月,共完成婴儿TOF根治术128例,其中男性82例,女性46例,年龄6个月～2岁。手术全部正中开胸,采用右室流出道纵切口,合理疏通右室流出道,聚四氟乙烯补片修补室间隔缺损,自体心包片加宽流出道,撤离体外循环前常规应用改良超滤技术。结果全组128例中121例手术获得成功,7例死亡,手术早期死亡率5.5%,死亡原因包括严重低心排综合征2例、严重肺部并发症4例、多器官功能衰竭1例。术后主要并发症包括:低心排综合征12例,肺不张5例,灌注肺6例。结论TOF行根治手术以1岁左右为宜,在婴儿期进行根治术可以取得满意的临床结果。低心排和严重的呼吸系统并发症是婴幼儿TOF根治术后面临的主要问题。

Objective To sum up the experiences in radical surgery for tetralogy of Fallot （TOF） in infancy. Methods One hundred and twenty-two infants （82 males and 46 females, 6 months to 2 years old） suffered from TOF were treated with radical surgery from January 1996 to December 2007. Median sternotomy was routinely performed in all patients, and a longitudinal incision of right ventricular outflow tract was made to widen the conduit adequately, the ventricular septal defect was closed with polyfluortetraethylene patch, and the outflow conduit was reconstructed by autologous pericardial patch. Modified ultrafiltration technique was adopted routinely before cardiopulmonary bypass termination. Results Seven of the 128 infants died after operation with the early mortality of 5. 5%. The death causes were： severe low cardiac output syndrome （n= 2）, severe pulmonary complications （n= 4） and multiple organ failure （n= 1）. The major post-operative complications included 12 eases of low cardiac output syndrome, 5 cases of ateleetasis and 6 cases of perfusion lung. Conclusions The preferable operative age of radical surgery for TOF is about 1 year old, and the clinical outcome could be satisfactory. Low cardiac output syndrome and severe respiratory complications are the major problems after radical surgery for TOF in infants.