婴儿期不同月龄段对法洛四联症根治术手术效果的影响

Influence of total correction in different ranges of infants less than 12 months old with tetralogy of Fallot

目的评价手术年龄对婴儿法洛四联症(tetralogy of Fallot,TOF)早期根治术的影响。方法回顾性分析2008年1月至2010年3月在广州市妇女儿童医疗中心住院,43例行手术治疗的小于12个月的TOF患儿的临床资料。根据月龄分为两组:A组19例,年龄(3.2±1.4)个月;B组24例,年龄(7.7±1.9)个月。比较两组手术方式、术后并发症、各项观察指标及随访结果。结果两组均没有手术死亡患儿;两组术后并发症比较,差异无统计学意义(P>0.05)。A组术后呼吸机通气时间[(59.3±47.1)h vs.(26.3±23.8)h,P<0.05]和重症监护时间[(109.8±60.8)h vs.(70.5±41.6)h,P<0.05]比B组更长,差异有统计学意义。两组体外循环时间、主动脉阻断时间、强心药指数、住院时间比较,差异均无统计学意义(P>0.05)。全组患儿随访(12.5±3.5)个月,无晚期死亡,均存在不同程度肺动脉瓣反流,无残余右心室流出道梗阻,2例残余室间隔缺损,但无需再次手术。结论婴儿期不同年龄段对TOF根治术的手术效果无明显影响。

Objectives To evaluate the outcome of early total correction in different ranges of infants less than 12 months old with tetralogy of Fallot （TOF）. Methods Clinical data of 43 infants less than 12 months old undergone total correction of isolated TOF from January 2008 to March 2010 in Guangzhou Women and Children＇ s Medical Center were reviewed. The infants were divided into 2 groups according to the age： 19 in group A aged （3.2±1.4） months; 24 in group B aged （7.7±1.9） months. Operation methods, postoperative complications, other observation indexes and follow-up outcomes between the two groups were compared. Results There was no mortality in two groups. There were no significant differences of postoperative complications between the two groups （P〉0.05）. Duration of ventilation [ （59.3±47.1） h vs. （ 26.3±23.8 ） h, P〈0.05 ] and duration of intensive care [ （ 109.8±60.8 ） h vs. （70.5±41.6） h, P〈0.05 ] in group A were significantly longer than those in group B. There were no significant differences in duration of external circulation, aortic clamping time, index of cardiotonie, duration of hospitalization between the two groups （P〉 0.05）. After followed up for （12.5±3.5） months, no death and no residual right ventricular outflow tract obstruction showed in the 43 infants. All of them had pulmonary regurgitation at different levels. Residual ventricular septal defect showed in 2 patients, but reoperation was not required. Conclusions Different ranges of infants less than 12 months do not effect the outcome of total correction of TOF.