86例婴幼儿法洛四联症外科治疗体会

Surgical experience of tetralogy of fallot in infant

目的总结86例婴幼儿法洛四联症外科治疗经验。方法2009年1月至2011年12月，我院共行法洛四联症外科手术86例，年龄6-36个月，其中根治术83例，中心性分流术3例。全部采用胸骨正中切口，根治者经右室流出道切口完成疏通解除右心梗阻，用Dacron补片修补室间隔缺损。右室流出道切1：3直接缝合25例，自体心包片加宽16例，牛心包带瓣补片跨环加宽右室流出道及肺动脉42例，合并畸形同期矫治。中心性分流3例采用Gore—Tex管道建立主动脉到肺动脉连接。结果术后早期死亡2例，死亡率2．3％。死亡原因：1例为低心排综合征，另1例为严重肺部感染。术后主要并发症为低心排综合征9例，灌注肺3例，一过性肾功能衰竭5例，肺不张6例。结论根据病变采取不同术式，术中完善的右室流出道疏通及术后低心排综合征防治是法洛四联症手术成功的关键。

Objective To sum up the surgical experience of 86 cases of tetralogy of fallot （TOF） in in- fants. Methods Between Jan 2004 and De 2011, 86 cases of TOF（6 to 36 months） received radical surgery （83） or central shunt（3 ） in our hospital. All of the operation were performed through stereotomy, radical surgery through right ventricular outflow tract incision with a Dacron patch to repair the ventricular septal defect, right ventricular outflow tract （RVOT） incision was sutured directly in 25 cases, in 16 cases RVOT was widened with autologous pericardium, in 42 cases RVOT and pulmonary artery were widen using bovine pericardium valved patch , other abnormalism was corrected at the same time. The aorta to the pulmonary artery connection was established using Gore-Tex Pipe in the 3 cases of central shunt. Results Early postoperative mortality was 2.3% （2/86）, the caus- es of death were low cardiac output syndrome （LOWS） and severe lung infections. The main complications were low cardiac output syndrome （9）, perfusion lung（3）, transient renal failure（5）, atelectasis（6）. Conclusion Op-eration can be performed with different methods in TOF according to different pathologic features. Relief of RVOT obstruction and prevention of LOWS were the key points of successful operation.