论文部分内容阅读
目的总结外科治疗婴儿法洛四联症(TOF)的临床经验,并对早期、中期疗效进行评价。方法 142例婴儿TOF,术前经心脏彩超和(或)心脏CTA检查确诊,其中男性79例,女性63例;年龄1~12个月,平均(6.4±2.7)个月;体质量3.0~12.0kg,平均(6.7±1.4)kg。McGoon值0.80~2.47,平均1.59±0.34;左室舒张末容积指数14.0~36.3mL/m2,平均(25.5±5.9)mL/m2。138例在中度低温体外循环下行一期根治术,4例行分期根治手术。结果体外循环时间(95.0±21.7)min,主动脉阻闭时间(54.3±15.1)min,术后呼吸机辅助时间(40.2±30.5)h,监护室停留时间(5.0±3.5)d。治愈出院140例,死亡2例(院内死亡率1.4%)。术后二次手术4例(2.8%)。术后并发症主要为低心排出量综合征、肺部感染、急性肾衰竭等,并发症发生率为7.0%(10/142)。随访患儿127例,随访率89.4%,随访时间11~62个月(中位数37个月),均无死亡或再次手术;心功能Ⅰ级117例(92.1%),心功能Ⅱ级10例(7.9%);心脏超声提示右室射血分数(EF)均正常,微量或少量肺动脉瓣反流113例(89.0%),中量反流14例(11.0%),无大量反流。结论婴儿期行TOF根治术是安全有效的,优化手术方法及加强围手术期管理是提高婴儿期TOF手术成功率的关键,术后早期和中期疗效满意。
Objective To summarize the clinical experience of surgical treatment of tetralogy of Fallot (TOF) in infants and to evaluate the early and intermediate effects. Methods 142 infants with TOF were diagnosed preoperatively by echocardiography and / or cardiac CTA, including 79 males and 63 females. The average age was from 1 to 12 months (6.4 ± 2.7 months), and the body weight was 3.0-12.0 kg, mean (6.7 ± 1.4) kg. McGoon values ranged from 0.80 to 2.47 with an average of 1.59 ± 0.34; left ventricular end-diastolic volume index ranged from 14.0 to 36.3 mL / m2 with an average of (25.5 ± 5.9) mL / m2.138 underwent primary hypothermic cardiopulmonary bypass, Staging surgery. Results The time of cardiopulmonary bypass (95.0 ± 21.7) min, the time of obstruction of aorta (54.3 ± 15.1) min, the duration of postoperative ventilator assisting time (40.2 ± 30.5) h, and the stay of care unit (5.0 ± 3.5) d. 140 patients were cured and 2 died (hospital mortality 1.4%). Four postoperative second surgery (2.8%). Postoperative complications were mainly low cardiac output syndrome, pulmonary infection, acute renal failure, the incidence of complications was 7.0% (10/142). There were 127 cases with follow-up rate of 89.4% and the follow-up time ranged from 11 to 62 months (median 37 months). There were no death or reoperation in this group. 117 cases (92.1%) had grade I heart function, (7.9%). Echocardiography showed normal right ventricular ejection fraction (EF), with trace or regurgitation in 113 cases (89.0%) and moderate reflux in 14 cases (11.0%) with no significant reflux. Conclusions TOF in infancy is safe and effective. Optimizing surgical methods and improving perioperative management are the keys to improve the success rate of TOF in infancy. The early and mid-term outcomes are satisfactory.