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| 142例婴儿法洛四联症的外科治疗:附5年随访资料 |
| 张本1,2,许炜3,张卫达1*,王晓武1,王显悦1,童光1,马涛1 |
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(1. 广州军区广州总医院心血管外科中心, 广州 510010;
2. 广州华博生物制药研究所, 广州 510663;
3. 广州军区广州总医院眼科, 广州 510010
*通信作者) |
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| 摘要: |
| 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3.0~12.0 kg，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14.0~36.3 mL/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。 |
| 关键词: 法洛四联症 婴儿 心脏外科手术 围手术期医护 随访 |
| DOI：10.16781/j.0258-879x.2017.01.0119 |
| 投稿时间：2016-04-09修订日期：2016-10-03 |
| 基金项目:国家自然科学基金（81500298），广东省自然科学基金（2014A030310473），广州市珠江科技新星专项（201610010094）. |
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| Surgical treatment of tetralogy of Fallot in 142 infants: 5-year follow-up data |
| ZHANG Ben1,2,XU Wei3,ZHANG Wei-da1*,WANG Xiao-wu1,WANG Xian-yue1,TONG Guang1,MA Tao1 |
(1. Center of Cardiovascular Surgery, Guangzhou General Hospital, PLA Guangzhou Military Area Command, Guangzhou 510010, Guangdong, China;
2. Huaoo Biological Pharmaceutic Research Institute, Guangzhou 510663, Guangdong, China;
3. Department of Ophthalmology, Guangzhou General Hospital, PLA Guangzhou Military Area Command, Guangzhou 510010, Guangdong, China
*Corresponding author) |
| Abstract: |
| Objective To summarize the clinical experiences of surgical treatment of tetralogy of Fallot (TOF) in infants, and to evaluate its short- and mid-term efficacy. Methods The clinical data of 142 infants with TOF preoperatively diagnosed by cardiac color Doppler ultrasound and/or cardiac CT angiography were retrospectively reviewed. There were 79 males and 63 females with a mean age of (6.4±2.7) months (range 1-12 months) and a mean body weight of (6.7±1.4) kg (range 3.0-12.0 kg). The mean McGoon index was 1.59±0.34 (range 0.80-2.47), and the left ventricular end diastolic volume index was 25.5±5.9 (range 14.0-36.3). One-stage radical operation was performed in 138 cases under moderate hypothermic cardiopulmonary bypass, and staging radical operation was performed in 4 cases. Results The mean time of cardiopulmonary bypass, arrest of the ascending aorta, post-operative ventilation, and ICU stay were (95.0±21.7) min, (54.3±15.1) min, (40.2±30.5) h, and (5.0±3.5) d, respectively. Two cases died in the early postoperative period, with the mortality being 1.4%. Reoperation in the early postoperative period was performed in 4 cases (2.8%). The incidence rate of postoperative complications was 7.0% (10/142), including low cardiac output syndrome, pulmonary infection, acute renal failure and so on. Medium term clinical follow-up was achieved in 127 (89.4%) cases. The mean follow-up time ranged from 11 to 62 months (median 37 months). There was no death or reoperation during the follow-up period. The cardiac function NYHA classⅠwas found in 117 cases, and class Ⅱ in 10 cases. During the follow-up period, all patients had normal right ventricular ejection fraction, and various degrees of pulmonary regurgitation (PR), including trace or mild PR in 113 cases (89.0%) and moderate PR in 14 cases (11.0%). Conclusion Radical operation of TOF in infants is safe and effective, with satisfactory short- and medium-term outcomes. Optimizing operation method and strengthening the perioperative management are the keys to improve the successful rate of operation in TOF infants, with satisfactory early- and mid-term curative effect. |
| Key words: tetralogy of Fallot infant cardiac surgical procedures perioperative care follow-up |
