右外侧小切口剖胸行婴幼儿法洛四联症根治术治疗体会

Postoperative treatment for infants and young children tetralogy of Fallot radical surgery through right thoracotomy approach

目的:总结0～3岁婴幼儿经右外侧小切口剖胸行法洛四联症(TOF)根治手术的结果及治疗体会。方法:回顾性分析2011年1月至2011年12月完成的0～3岁TOF根治术142例,经右外侧小切口剖胸进行的TOF根治术47例,经正中剖胸进行的TOF根治术95例,对比2组患儿的术前血氧饱和度、血红蛋白、McGoon比值,术中体外循环时间和主动脉阻断时间以及术后当日胸腔引流量、左心房压、正性肌力药物评分、呼吸机使用时间,监护室停留时间和术后住院时间。结果:经右外侧小切口剖胸进行的TOF根治术47例,其中跨环补片15例(占32%)。本组平均年龄(13.34±6.41)个月(5～34个月),平均体质量(9.58±1.17)kg(6～14 kg),术前血氧饱和度(87.57±9.02)%(69%～99%),McGoon比值2.06±0.48(1.11～3.36),术中体外循环时间(95.95±26.31)min(40～170 min),主动脉阻断时间(67.95±17.57)min(30～117 min),术后当日胸腔引流量(10～850 mL),中位数胸腔引流量110(80,167)mL,左心房压(9.19±2.12)mmHg(3～14 mmHg),正性肌力药物评分8.57±3.97(2～19),呼吸机使用时间(4～165 h),中位数呼吸机使用时间21.5(14.2,36.5)h,监护室停留时间(2.86±1.94)d(0～9 d)。术后因胸腔引流过多二次开胸探查2例。残余分流2例(2 mm)。与同期相匹配95例正中剖胸TOF根治术相比,术前临床资料无差异,术中体外循环时间和主动脉阻断时间无差异,术后右外侧小切口剖胸组监护室停留时间明显短于正中剖胸组,正性肌力药物评分及术后左心房压明显低于正中剖胸组。其余各项均与正中剖胸组无差异。结论:在熟练掌握手术技巧,严格手术适应证选择的基础上,右外侧小切口剖胸可以在TOF根治手术中应用。

Objective： To summarize treatment experience for 0-3-year-old infants and young children tetralogy of Fallot （TOF） radical surgery through right thoracotomy. Methods： Retrospective analysis from Jan- uary 2011 to December, 142 cases aged 0-3 years receiving TOF of radical surgery. 47 cases receiving TOF of radical surgery through the right thoracotomy and 95 cases receiving TOF of radical surgery through the middle thoracotomy were enrolled in this study. Compared two groups of children with preoperative oxygen saturation, hemoglobin, McGoon ratio, intraoperative cardiopulmonary bypass time and aortic cross-clamping time, and postoperative chest drainage, left atrial pressure, positive inotropie drug score, ventilator time, intensive care unit stay and postoperative hospital stay. Result： There were 47 patients receiving TOF of radical surgery through the right thoracotomy approach. It consists of 15 patients （32%） in the transannular patch. The aver-age age was （13. 34±6. 41 ） months （5 -34 ）months in this group, while the average weight was （9. 58±1.17）kg （6-14 kg）, preoperative mean oxygen saturation was （87.57±9. 02）% （69%-99% ）, McGoon ratio was 2. 06-0. 48 （ 1.11±3.34）. Two patients received second thoracotomy for exploration because of ex- cessive chest drainage. Residual shunt was conducted in 2 patient （2ram）. Compared with similar to those of 95 cases with TOF through the middle thoracotomy at the same period, the preoperative clinical data was no difference, the intraoperative cardiopulmonary bypass time and aortic cross-clamping time were no difference, and the postoperative care unit stay time was shorter than the middle of the thoracotomy group, positive inotropic drug score and left atrial pressure was lower than the middle of the thoracotomy group. There was no difference in the rest outcomes between the two groups. Conclusion：Given proficient surgical skills and strict inclusion of indications, the small incision of the right lateral thoracotomy TOF radical surgery could be carried out.