婴幼儿法洛四联症经右房-肺动脉外科矫治手术

Surgical Treatment for Tetralogy of Fallot in Infants Through Right Atrium and Pulmonary Artery Route

目的:探讨婴幼儿法洛四联症经右房、三尖瓣修补室缺保护右心功能、切开肺动脉并用心包补片扩大、肺动脉瓣成形的外科治疗策略,以提高手术安全性及降低术后并发症和病死率。方法:回顾分析总结手术治疗40例婴幼儿法洛四联症手术方案。结果:手术死亡1例,死亡率为2.5%。存活病例中,发生低心排综合征3例,发生率为7.5%;急性肾功能衰竭行腹膜透析5例,发生率为12.5%;肺部感染15例,发生率为37.5%;无小室缺残余漏,所有存活患者无一例发生Ⅲ度房室传导阻滞,经治疗后均痊愈出院。结论:积极合理的围手术期处理和精细的手术技巧是手术治疗成功的关键。

Objective To improve the safety of treating infantile tetralogy of fallot（TOF） and reduce the postoperative complications and mortality by exploring the repair of ventricle through right atrium（RA） and tricuspid valve（TV） to protect the right ventricular（RV） function,open pulmonary artery and expand pulmonary artery with pericardium patch and pulmonary valvuloplasty.Method：Reviewed and analyzed surgical treatment for 40 infants with tetralogy of Fallot（TOF）.Result：One patient died in the early postoperative period,mortality rate was 2.50%.Low cardiac output syndrome（LCOS） was noted in 3 cases,mortality rate was 7.5%.Acute renal failure（ARF） was noted in 5 cases（12.5%） and were given peritoneal dialysis（PD）,pulmonary infection was noted in 15 cases,mortality rate was 37.5%.NO residual leakage and third degree atrioventricular block happened.The rest of patients were recovered and discharged from hospital. Conclusion： Positive and rational perioperative management and subtle surgical technique were the keys to success of surgical treatment.