三种手术方式一期根治左心室较小型小儿法洛四联症的临床效果比较

Clinical effect comparison of three operations for one-stage radical correction of small left ventricle in children with tetralogy of Fallot

目的对比三种手术方式在左心室较小型小儿法洛四联症(tetralogy of Fallot,TOF)一期根治手术中的临床效果。方法回顾性分析2004年12月至2017年5月河北医科大学第一医院行一期根治手术120例左心室较小型TOF患者的临床资料。根据不同的手术方式将患者分为三组,其中一般方法手术组30例,男16例、女14例,年龄3~24(11.58±2.05)个月;大补片组40例(采用比室间隔缺损略大补片修补缺损),男22例、女18例,年龄3~25(11.22±2.24)个月;室间隔缺损扩大组50例(采用新型左心室扩大技术扩大室间隔缺损),男26例、女24例,年龄3~22(10.17±2.15)个月。对比三种手术方式的临床效果。结果室间隔缺损扩大组与其余两组相比,术后低心排血量综合征发生率(6.0%vs.40.0%vs.50.0%,P<0.05)、肾功能不全发生率(4.0%vs.37.5%vs.46.7%,P<0.05)、感染率(10.0%vs.50.0%vs.66.7%,P<0.05)及死亡率(2.0%vs.12.5%vs.20.0%,P<0.05)低,呼吸机辅助呼吸时间[(8.34±5.24)h vs.(36.14±10.91)h vs.(38.58±10.12)h,P<0.05]、监护室停留时间[(4.13±1.01)d vs.(7.64±2.11)d vs.(8.03±3.03)d,P<0.05]及住院时间[(10.48±4.26)d vs.(21.02±3.23)d vs.(22.52±2.93)d,P<0.05]短,住院费用少[(5.13±0.94)万元vs.(10.32±3.93)万元vs.(11.55±3.52)万元,P<0.05]。结论在左心室较小型小儿TOF根治术中,室间隔缺损扩大组手术临床效果优于一般方法手术组和大补片组,长期疗效需待进一步随访。

Objective To compare the clinical effect of three operations for one-stage radical correction of smaU left ventricle in children with tetralogy of Fallot （TOF）. Methods We retrospectively analyzed the clinical data of 120 patients with left ventricular dysplasia and TOF undergoing one-stage radical surgery in the First Hospital of Hebei Medical University from December 2004 to May 2017. According to the different types of operation used, they were divided into 3 groups, including a routine group （30 patients, 16 males and 14 females, aged 11.58±2.05 months ranging from 3-24 months）, a large patch group （40 patients, 22 males, 18 females, aged 11.22±2.24 months ranging from 3-25 months） who were treated with a large patch, and an enlarged ventricular septal defect group （50 patients, 26 males, 24 females, aged 10.17±2.15 months ranging from 3-22 months） using new left ventricular enlargement technique to enlarge ventricular septal defect. The clinical effect of the three operations were compared. Results The incidence of postoperative low cardiac output syndrome （6.0% vs. 40.0% vs. 50.0%, P〈0.05）, renal failure （4.0% vs. 37.5% vs. 46.7%, P〈0.05）, infection rate （10.0% vs. 50.0% vs. 66.7%, P〈0.05）, mortality （2.0% vs. 12.5% vs. 20.0%, P〈0.05）, ventilator-assisted time （8.34±5.24 h vs. 36.14±10.91 h vs, 38.58±10.12 h, P〈0.05）, ICU stay （4.13±1.01 d vs. 7.64±2.11 d vs. 8.03±3.03 d, P〈0.05）,hospital stay （10.48±4.26 d vs. 21.02±3.23 d vs. 22.52±2.93 d, P〈0.05） and hospitalization costs （51 300±9 400 yuan vs. 103 200±39 300 yuan vs. 115 500±35 200 yuan, P〈0.05） were less in the enlarged ventricular septal defect group compared with the other two groups. Conclusion The clinical effect of enlarged ventricular septal defect is better than that of the routine and large patch methods, and long-term efficacy should be further followed up.