成人法洛四联症75例的外科治疗

Surgical Treatment of Tetralogy of Fallot in 75 Adults

目的总结成人法洛四联症(TOF)的外科治疗经验,分析其疗效。方法 2002年7月至2009年8月第四军医大学西京医院共75例成人法洛四联症患者接受外科治疗,男35例,女40例;年龄17～37岁(23.30±3.50岁)。均自幼紫绀,有杵状指(趾)。术前血红蛋白143～231g/L(172.00±31.00g/L)。75例术前均经超声心动图确诊,均在低温体外循环下行法洛四联症矫治术。46例采用跨环补片加宽右心室流出道和肺动脉,29例行右心室流出道补片加宽。结果手术时间157～276min(221.32±41.34min),体外循环时间68～163min(91.71±28.35min),主动脉阻断时间37～96min(55.47±23.61min)。死亡6例,病死率8.00%。死亡原因:术后低心排血量综合征3例,急性肾功能衰竭2例,多器官功能衰竭1例。9例因术后引流量多,再次开胸止血(12.00%)。随访69例,随访时间3～56个月(26.31±7.40个月)。2例术后3个月经超声心动图复查发现室间隔缺损残余漏。69例患者心功能(NYHA)均恢复至Ⅰ～Ⅱ级,无晚期死亡。结论成人法洛四联症手术治疗效果满意。

Objective To evaluate the results of surgical treatment of tetralogy of Fallot in adults.Methods From July 2002 to August 2009,75 adult patients with tetralogy of Fallot received surgical treatment in Xijing Hospital,Forth Military Medical University.There were 35 males and 40 females,with age at l7 to 37 years（23.30±3.50 years）,and preoperative hemoglobin at 143 to 231 g/L（172.00±31.00 g/L）.All these patients were diagnosed by echocardiograph before operation.All the patients were received tetralogy of Fallot of corrective operation in the hypothermia cardiopulmonary bypass.A total of 46 patients had a transannular right ventricular outflow tract patch,and 29 patients had a non transannular patch.Results Operation time was 157 to 276 min（221.32±41.34 min）,cardiopulmonary bypass time was 68 to 163 min（91.71±28.35 min） and aorta intercepted time was 37 to 96 min（55.47±23.61 min）.There were 6 operative deaths with an operative mortality at 8.00%. The causes of death were low output syndrome（n=3）,acute renal failure（n=2）,and multiple organ failure（n=1）.Nine patients needed reoperation for postoperative bleeding（12.00%）.We followed up 69 patients from 3 to 56 months（26.31±7.40 months）.There were 2 patients with trivial residual shunt.The cardiac function status were New York Heart Association（NYHA） Ⅰ to Ⅱ in the 69 patients.No late death occured.Conclusion The effectiveness of surgical treatment for adults with tetralogy of Fallot is satisfactory