婴幼儿法洛四联征177例外科治疗

摘要

目的:总结婴幼儿法洛四联征(TOF)外科手术经验.方法:选取我院177例患法洛四联征患儿,1例二行中心分流姑息手术,其余均行根治术,其中102例给予右心室流出道(RVOT)心包补片,72例给予跨瓣环心包补片,其中12例加宽至左肺动脉,单冠脉畸形影响右室流出道1例行右室一肺动脉外管道,1例游离肺动脉与右室直接吻合.全组均使用膜肺、全胶体预充并采用改良超滤技术.结果:治愈171例,手术死亡6例,死亡率为3.39%.合并低心排出量综合征7例,急性肾功能衰竭5例,消化道大出血2例,肺部感染5例.结论:婴幼儿TOF行根治手术效果良好,早期手术有利于患儿全身重要器官的发育.合理畸形矫治是手术成功的关键,术中麻醉、体外循环技术及术后管理也非常重要.%Objective: To summarize the experience of surgical treatment in 177 infants with tetraloge of Fallot (TOF).Methods: 177 infants with tetraloge of Fallot were selected in our hospital, one case were operated in central shunt, and the others were operated in total surgical correction, 102 cases were given pericardial patches of right ventricular outflow tract (RVOT), 72 cases were given crossing valvula pericardial patches, 12 cases of outflow tract were widened to left pulmonary artery, one case was operated in right veutricle to pulmonary artery conduit, and one case was operated in right veu-tricle to pulmonary artery directly.Aolloidal dispersion and modified ultrafiltration were used in the operation.Results: 171 cases were cured, and 6 cases were death with the mortality of 3.39％.There were 7 cases with serious low cardiac output syndrome, 5 cases with acute respiratory distress syndrome, 2 cases with the upper gastrointestinal bleeding, and 5 cases with lung infection.Conclusion: The radical operation was satisfactory in the treatment of infants with TOF.Early surgical treatment is advantageous to the growth of important organs for infants with TOF.Reasonable abnormality rectification is critic to the success of surgical treatment of TOF in infants.Anaesthesia, bypass technique and treatment after operation are very important.