一期外科手术治疗婴儿期法洛四联症77例

Early Primary Surgical Treatment on Tetralogy of Fallot in 77 Infants

目的探讨一期外科手术治疗婴儿期法洛四联症(TOF)的经验。方法 2002年1月-2010年2月本科共收治TOF患儿77例。男46例,女31例;年龄2～12个月[(9.06±2.72)个月];体质量3.5～10.0 kg[(5.98±0.96)kg]。≤6个月组28例,7～12个月组49例,均行TOF一期根治术,其中10例术前有缺氧发作而行亚急诊手术治疗。比较不同年龄组围术期处理方法、手术死亡率、并发症及随访结果。结果 TOF77例中,术后死亡3例(3.89%),均死于术后低心排综合征,其余均治愈出院。≤6个月与7～12个月婴儿TOF比较,术后低心排综合征发生率较高(χ2=6.45,P<0.05),且前者应用肾上腺素、葡萄糖酸钙的使用率较高(χ2=13.67、19.96,Pa<0.05),呼吸机辅助时间、ICU停留时间及住院时间较长(t=2.254、2.297、2.631,Pa<0.05)。术后随访6个月～5 a,无远期死亡,患儿生长发育均良好。结论 <6个月婴儿TOF可以早期施行一期外科纠治,近期效果满意,而远期效果良好。

Objective To explore the experience of early primary surgical treatment on tetralogy of fallot（TOF） in infants.Methods Seventy-seven TOF cases were received in the Department of Cardiovascular Surgery from Jan.2002 to Feb.2010 with 46 male and 31 female,ages ranging from 2 months to 12 months.The mean age was（9.06±2.72） months.The patients′ weight ranged from 3.5-10.0 kg,（5.98±0.96） kg on average.Of all the patients,28 cases were under 6 months old and 49 cases aged from 7 to 12 months.All the patients were given radical TOF operation,10 cases of whom were given sub-emergency surgery because of preoperative hypoxia.Perioperative management,operative mortality,complications and follow-up findings different age groups were compared and analyzed.Results Of the 77 cases,3 cases died of low cardiac output syndrome.The rest were cured.Compared with patients with TOF aged 7-12 months old,patients with TOF under 6 months developed a higher rate of postoperative low cardiac output syndrome（χ2=6.45,P0.05） and had higher frequency of applying adrenalin and calcium gluconate（χ2=13.67,19.96,Pa〈0.05）,longer mechanical ventilation,longer time of ICU stay and hospita-lization（t=2.254,2.297,2.631,Pa〈0.05）.Postoperative follow-up lasted from 6 months to 5 years,and no late death was reported and all the patients developed well.Conclusions Earlier primary repair can be performed safely in patients with TOF under 6 months old and it had a better short-term and long-term curative rate.