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目的总结儿童法洛四联症根治术的经验,探讨手术时机、手术方法及围术期管理。方法对在本院行根治术的74例法洛四联症患儿临床资料进行回顾性分析。男46例,女28例;手术时年龄(7.6±2.5)岁(11个月～14岁);体质量(12.9±5.6)kg(9.8～21.4 kg)。术前评估标准为左心室发育较好,左心室舒张末期容量指数>30 mL.m-2,肺动脉发育较好,术前重要脏器功能无严重损害,符合上述指标者均在体外循环、中低温下行手术治疗。结果患儿均行根治术,冷血心脏停跳液诱导心脏停跳,采用右心房及右心室流出道切口,行右心室流出道重建及室间隔补片修补,56例行跨瓣补片。术后71例恢复良好,3例死亡。其中2例死于低心排综合征,1例死于肺水肿并肾衰竭,病死率为4.05%。患儿复诊及电话随访至今,均可正常生活及学习。结论法洛四联症患儿早期行根治术,效果满意。把握合适的手术时机,心脏畸形完全矫正和及时处理术后并发症是手术成功的关键。
Objective To summarize the experience of radical surgery of tetralogy of Fallot in children and explore the timing of operation, surgical methods and management of perioperative period. Methods The clinical data of 74 patients with tetralogy of Fallot undergoing radical operation in our hospital were retrospectively analyzed. There were 46 males and 28 females with a mean age of 7.6 ± 2.5 years (ranged from 11 months to 14 years) and a mean body weight of 12.9 ± 5.6 kg (9.8 to 21.4 kg) at the time of surgery. Preoperative evaluation criteria for the development of the left ventricle better, the left ventricular end-diastolic volume index> 30 mL.m-2, better pulmonary artery development, preoperative function of important organs without serious damage, in line with these indicators were in cardiopulmonary bypass, medium Low temperature surgical treatment. Results All children underwent radical surgery, cold-beating cardioplegia induced cardiac arrest, right atrium and right ventricular outflow tract incision, right ventricular outflow tract reconstruction and ventricular septal patch repair, 56 cases of trans-flap patch. 71 cases recovered well and 3 died. Two of them died of low cardiac output syndrome, one died of pulmonary edema and renal failure, with a case fatality rate of 4.05%. Children’s referral and telephone follow-up so far, can be normal life and learning. Conclusion Tetralogy of Fallot patients underwent radical surgery at early stage, with satisfactory results. Grasp the appropriate timing of surgery, complete correction of cardiac deformity and timely treatment of postoperative complications is the key to the success of the operation.