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目的：本文通过３６０例３个月至５岁小儿法乐四联症的根治术，介绍如何降低手术死亡率的经验。方法：１９９３年１月至１９９５年９月，为３６０例（男２６５例，女９５例）３个月至５岁的患儿行法乐四联症根治术，平均年龄２．７６±１．４９岁，平均体重１１．４５±３．２５（５～１９）ｋｇ。全麻、深低温（鼻温２０℃）、低流量（２０～４０ｍｌ·ｋｇ－１／ｍｉｎ）体外循环下行根治术，包括修补心室间隔缺损，右心室流出道加宽。１３８例（３８．３３％）跨环补片，１０７例至左右肺动脉分叉处或左肺动脉起始部，２６例用液氮保存的同种带瓣升主动脉（１９例取自新生儿，７例取自成人），手术同期纠正其他心内畸形１８７例（５１．９４％）。结果：手术死亡４例（１．１１％），死因为灌注肺２例，心包填塞及呼吸衰竭各１例。结论：尽管手术适应证较宽，但手术死亡率近年明显下降，这主要与术前纠正贫血、畸形纠正满意、心肺保护良好和正确的术后处理有关。
OBJECTIVE: This article describes the experience of reducing surgical mortality through the radical surgery of 360 children with tetralogy of Fallot from 3 months to 5 years of age. Methods: From January 1993 to September 1995, 360 patients (265 males and 95 females) underwent radical surgery for tetralogy of Fallot with a mean age of 2.76 ± 1 at 3 months to 5 years old. 49 years old, average body weight 11.45 ± 3.25 (5 ~ 19) kg. General anesthesia, deep hypothermia (nose temperature 20 ℃), low flow (20 ~ 40ml · kg-1 / min) undergoing cardiopulmonary bypass radical surgery, including repair of ventricular septal defect, right ventricular outflow tract widening. 138 cases (38.33%) of trans-annular patch, 107 cases to the left or right pulmonary artery bifurcation or the beginning of the left pulmonary artery, 26 cases of the same type of ascending aorta preserved with liquid nitrogen (19 cases taken from newborns, 7 cases were taken from adults), 187 cases (51.94%) of other intracardiac malformations were corrected during operation. Results: 4 cases died of surgery (1.11%), 2 died of pulmonary perfusion, 1 case of pericardial stuffing and respiratory failure. CONCLUSIONS: Despite the wide range of surgical indications, operative mortality has decreased significantly in recent years, primarily related to correct anemia before surgery, satisfactory correction of deformities, good cardiopulmonary protection, and correct postoperative management.