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目的总结重症法洛四联症分期手术治疗的临床经验。方法自2011年2月至2012年12月共收治重症法洛四联症分流术后患儿26例,二期行根治手术,其中男18例,女8例;年龄9个月～6岁,平均(3.2±3.3)岁,体重6.0～16.2kg,平均(10.2±5.1)kg。观察所有患儿术后并发症,并对术后患儿的心功能进行2年随访。结果本组患儿中1例术后室缺残余漏,分流术宽2mm,3个月复查室水平无分流,1例术后第7天突发抽搐,急查颅脑CT示:脑脓肿,转入外院行开颅手术后痊愈出院,其余患儿均痊愈出院。术后随访2个月～2年,心功能均为I级(NYHA分级)。结论重症法洛四联症分流术后再次行二期根治术有良好的术后成功率,应注意首次手术方式的选择和有无合并症的存在。
Objective To summarize the clinical experience of staged surgery for severe tetralogy of Fallot. Methods From February 2011 to December 2012, 26 children with severe tetralogy of Fallot were admitted to the hospital after radical shunting. The second stage was performed radical surgery, including 18 males and 8 females; aged 9 months to 6 years old, Average (3.2 ± 3.3) years old, body weight 6.0 ~ 16.2kg, mean (10.2 ± 5.1) kg. All patients were observed postoperative complications, and postoperative cardiac function in children for 2 years follow-up. Results In this group, 1 patient had residual leak after surgery, width of shunt was 2mm, 3-month re-examination of ventricular level without shunt, 1 case of sudden convulsions on the 7th day postoperatively, acute brain CT examination showed: brain abscess, Transferred to the external hospital craniotomy recovered after discharge, the rest of the children were cured and discharged. The patients were followed up for 2 months to 2 years. The cardiac function was grade I (NYHA classification). Conclusion Severe tetralogy of Fallot quadruple surgery again after the second radical operation has a good success rate, should pay attention to the choice of the first surgical approach and the presence of complications.