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目的总结采用肺动脉后壁扩大法矫治合并左肺动脉狭窄的法洛四联症(TOF)的手术技术要点及效果。方法 2008年1月至2014年8月共1 142例患者在我院行TOF矫治术,合并左肺动脉严重狭窄的患者44例。其中21例采用肺动脉后壁扩大矫治左肺动脉狭窄的手术策略。年龄1个月至11岁,平均(22.8±33.9)个月,体重3.8~29.0(9.1±5.3)kg。结果 1例术中死亡,20例长期生存。4例术后出现单侧右肺渗出。心脏彩色超声心动图随访3~72个月,14例左肺动脉处无压差,6例残留压差(32.8±12.7)mm Hg。1例压差逐渐增大行介入球囊扩张。结论肺动脉后壁扩大法可有效矫治TOF合并的左肺动脉狭窄,扩大后补片,血流方向更顺畅。切断动脉导管可减少牵拉导致的肺动脉扭曲。同时该术式增加新建肺动脉的自体组织,有更好的生长潜力。
Objective To summarize the main technical points and effects of surgical treatment of tetralogy of Fallot (TOF) with left pulmonary artery stenosis by pulmonary artery posterior wall enlargement. Methods From January 2008 to August 2014, a total of 1 142 patients underwent TOF correction in our hospital, with 44 patients with severe left pulmonary artery stenosis. Among them, 21 cases were treated by pulmonary artery posterior wall enlargement to treat left pulmonary artery stenosis. The average age ranged from 1 month to 11 years (mean, 22.8 ± 33.9) months, and ranged from 3.8 to 29.0 (9.1 ± 5.3) kg body weight. Results 1 case died of surgery, 20 cases of long-term survival. Four cases of postoperative unilateral right lung exudation. Cardiac color echocardiography was followed up for 3 to 72 months. No pulmonary hypertension was observed in 14 patients. The residual pressure difference in 6 patients was (32.8 ± 12.7) mm Hg. One case of pressure increase gradually interventional balloon dilatation. Conclusions Pulmonary artery posterior wall enlargement can effectively treat left pulmonary artery stenosis associated with TOF. When enlarged, the direction of blood flow is smoother. Cut off the ductus arteriosus can reduce the distraction of the pulmonary artery caused by traction. At the same time, this technique increases the self-organization of new pulmonary artery and has better growth potential.