法乐四联症根治术疗效及其危险因素分析

Effect and Risk Factor Analysis for Total Correction of Tetralogy of Fallot

目的:评价法乐四联症根治术的疗效,分析相关危险因素,探讨改善手术疗效的措施。方法:总结近5年319例法乐四联症根治术的临床特点,采用多重线性回归分析等方法进行统计学分析,确定影响手术疗效的危险因素。结果:319例患者围术期发生恶性事件30例(9.4%),死亡13例(4.1%)。危险因素分析显示体重、左心室舒张末容积指数、体肺动脉侧支循环内径≥2 mm者、体外循环时间与围术期恶性事件的发生显著相关(P均<0.05),差异均有统计学意义。McGoon比值、左心室舒张末容积指数、体肺动脉侧支循环内径≥2 mm者、跨瓣环补片与围术期死亡显著相关(P均<0.05),差异均有统计学意义。结论:肺动脉、左心室发育情况和体肺侧支循环建立情况是评估法乐四联症根治术适应证的主要指标,全面的手术技巧和畸形矫治方法、良好的心肌保护及体外循环技术、积极的围术期处理,是手术成功的根本保证。

Objective ： To evaluate the effect and risk factors for total correction of tetralogy of Fallot（TOF） in order to improve the surgical treatment of TOF. Methods：We summarized the information of 319 consecutive patients who underwent the total correction of TOF from 2004 to 2009 in our hospital. The effect of operation and the risk factors for the early post-operative death and vicious complications were analyzed by T test, X~ test and multi regression analysis. Results ： 13 patients （ 4. 1% ） died and 30 patients （ 9.4% ） suffered from vicious complications at the early post-operative stage. The statistic analysis indicated that poor McGoon ratio,left ventricular end-diastolic volume index,the diameter of aortopul- monary collateral arteries ≥2 mm, prolonged cardiopulmonary bypass time and the application of trans-annular patching were the high risk factors for vicious complications and closely related to post-operative death,P 〈0. 05 respectively. Conclusion：The condition of pulmonary arteries, the development of left ventricle, and the establishmeut of aortoputmonary collateral circulation were the main indicators for the total correction of TOF. Appropriate surgical skills ,favorable myocardial protection and proper pert-operative management were critical for success of the operation.