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目的总结91例1岁以内进行法乐四联症(TOF)外科根治手术经验。方法2000年1月～2005年12月,我单位对91例小于1岁的TOF患儿进行Ⅰ期根治手术,手术时平均年龄为(7.92±0.4)个月(17 d～11.8个月);平均体重为(6.98±0.3)kg(1.7～10.2 kg);男63例,占69.2%,女28例,占30.8%;无症状3例,占3.3%,有症状88例,占96.7%,其中,缺氧发作的有23例,占25.3%。术前均经过心脏彩超和心导管及造影或心脏螺旋CT检查确诊。手术均在中到深低温体外循环下进行,93.4%的患儿行跨瓣环补片(TAP)扩大右室流出道,经右室或右房切口修补室间隔缺损,同期完成其他合并畸形的矫治。平均M率(McGoon Index)为1.88。结果总住院病死率为7.7%,平均主动脉阻断时间为55.2 min,体外循环时间为88.2 min,肺动脉瓣反流轻度65例,占71.4%,无Ⅲ度房室传导阻滞,轻度右室流出道梗阻5例。结论早期进行TOF根治手术可以取得良好的手术效果和相对低的手术病死率。
Objective To summarize the experience of 91 cases of surgical treatment of tetralogy of Fallot (TOF) within 1 year of age. Methods From January 2000 to December 2005, 91 cases of TOF children younger than 1 year were treated with stage Ⅰ radical gastrectomy. The mean age at the time of surgery was (7.92 ± 0.4) months (17 days to 11.8 months). The average body weight was (6.98 ± 0.3) kg (1.7-10.2 kg). There were 63 males and 69.2% females, 28 females, accounting for 30.8%, 3 asymptomatic males (3.3%) and 88 females (96.7% Among them, hypoxia attack in 23 cases, accounting for 25.3%. Preoperative ultrasound and cardiac catheterization and angiography or cardiac spiral CT examination confirmed. The surgery was performed under middle-to-hypothermic cardiopulmonary bypass. 93.4% of the children underwent trans-valvuloplasty (TAP) to expand the right ventricular outflow tract, and the right ventricle or right atrium incision to repair ventricular septal defect. At the same time, other combined malformations Correction. The McGoon Index was 1.88. Results The overall in-hospital mortality rate was 7.7%. The mean aortic block time was 55.2 min. The extracorporeal circulation time was 88.2 min. The pulmonary valve regurgitation was mild in 65 cases (71.4%). There was no grade Ⅲ atrioventricular block, mild Right ventricular outflow tract obstruction in 5 cases. Conclusion Early TOF radical surgery can achieve good surgical results and relatively low operative mortality.