改良Fontan手术的疗效分析

Results of the modified Fontan operation

目的 探讨改良Fontan手术后的早期效果 [以住院期间或 1个月 (住院超过 1个月者 )统计 ]及远期效果 (以手术后 5年统计 ) ,为其临床应用提供理论依据。方法 1990年 9月至 1996年 5月行改良Fontan手术病儿 5 2例 ,年龄 2 5～ 16岁 ,随访 49例 (93% ) ,平均随访时间 (5 2± 0 4)年。分析包括死亡、手术失败、心律失常、血栓形成、胸腔渗液等参数。结果 3例早期死亡 ,4例远期死亡 ;1例早期再次手术 ,1例远期再次手术。术后早期生存率 94% ,成功率 (不包括术后疗效不佳且危及生命 ,需二次手术者 ) 92 % ,室上性心动过速 6 % ,心动过缓 10 % ,胸腔渗液 38% ;术后远期生存率 87% ,成功率 83% ,室上性心动过速 10 % ,心动过缓 13% ,胸水渗出 6 %。结论 在复杂先天性心脏病的治疗中 ,即使应用于不同的解剖诊断病人 。

Objective: To evaluate the early and late results of the modified Fontan procedure. Methods: Between Sept. 1990 and May 1996, 52 patients (aged 2 5 years to 16 years) with a wide range of underlying diagnoses underwent the modified Fontan procedure at our institution. Follow up information was available for 48 patients [92%, mean follow up was (5 2±0 4) years]. Risk factors were analyzed including death, operation failure, bradyarrhythmia or tachyarrhythmia. Results: There were 3 early deaths and 4 late deaths. Early redo operation was performed in 1 patients and late redo operation in 1. Early postoperative survival rate was 94%. Free from failure, tachyarrhythmia accured(6%), bradyarrhythmia(10%), significant pleural effusion(38%). Late survival rate was 87%, free from failure, tachyarrhythmia 10%, bradyarrhythmia 13%, significant pleural effusions 6%. Conclusion: The modified Fontan procedure could result in good early and longterm outcome for complex congenital heart diseases with diverse anatomic diagnoses.