手术治疗婴幼儿法洛四联症83例

Surgical treatment of Tetralogy of Fallot in infancy： Experiences of 83 cases.

目的 总结婴幼儿法洛四联症（TOF）的外科手术情况,初步探讨手术时机、术式及与近期疗效的关系,以提高手术矫治效果.方法 2003年8月至2008年5月本院共手术矫治年龄≤3岁的TOF患儿83例（86次）.年龄2～36个月,体重3.5～13 kg.17例有反复缺氧发作,1例术前需呼吸机支持.患儿术前均行心脏彩超检查,1例行心血管造影.75例采取一期根治手术,68例经右房修补室间隔缺损,62例跨肺动脉瓣扩大右室流出道.根据Mcgoon指数以及左心室发育情况,8例采取姑息治疗（中央性体肺分流）,其中3例于11～15个月后行二期根治手术.结果 患儿McGoon指数≥1.28时预后良好.全组存活79例,根治、姑息治疗后各死亡2例,病死率4.7%（4/86）;二期根治患儿中无一例死亡.术后随访3～62个月,无死亡病例.结论 TOF患儿婴幼儿期采取一期根治可获得满意的近期效果,少数重症患儿仍需分期矫治.

Objective To discuss the correlations between surgical timing, operative methods and Shortterm effects of surgery so as to improve the effects of surgical correction for Tetralogy of Fallot （TOF） by evaluating the outcomes of surgical treatment in 83 infants with TOF. Methods From Aug 2003 to May 2008, surgical corrections were performed in 83 infants with TOF, aged from 2 to 26 moths, weight from 3.5 to 13 kg. All patients were diagnosed by echocardiography （ ECG）, one of which also by angiocardiography. Hypoxic spells were found in 17 cases before surgery, mechanical ventilation was needed in 1 of them. 75 cases underwent one-stage radical operations, about 90 percent of them had surgical repairs for ventricular septal defect （VSD） through right atrium approach, 62 cases received enlargement procedures of right ventricular outflow tract （ RV- OT） across the pulmonary valve ring. Palliative operation, systemic-pulmonary arterial shunt （Blalock-Taussig shunt or B-T shunt）, was used in 8 cases according to their McGoon index and left ventricle development status, two-stage radical operation was done in 3 of them 11 to 15 months later. Results Good prognosis can be ex- pected for infants＇ TOF when Mcgoon index 〉/ 1.28. 79 cases survived. Of 4 dead cases, 2 died after one - stage radical surgery and the other 2 after palliative procedure, with 4.7 percent of mortality. All cases were followed up from 3 to 62 months with no death found. Conclusions There is a significant positive correlation between the surgical effects and Mcgoon index. Respectable results can be found in the one - stage radical pro- cedures for infants＇ TOF. Two-stage surgical corrections are still needed in a few of severe eases.