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目的分析法洛四联症患者行改良BT分流术后的中期疗效。方法回顾性分析2006年7月至2013年1月上海交通大学医学院附属新华医院行改良BT分流术69例法洛四联症患儿的临床资料,男44例、女25例,手术年龄2个月至10岁,平均(17.97±24.73)个月;体重4~24(9.00±4.03)kg。所有患者均经右或左后外侧切口行锁骨下动脉-肺动脉分流术。结果该组患者随访6~36个月,其中获得6个月随访57例,同时获得6个月及12个月随访33例,同时获得12个月及24个月随访16例,同时获得24个月及36个月随访11例。法洛四联症患儿行改良BT分流术12个月内Mc Goon比增长显著,术后6个月Mc Goon比较术前明显增长(1.40±0.40 vs.1.09±0.33,P=0.00),术后12个月Mc Goon比较术后6个月Mc Goon比明显增长(1.36±0.33 vs.1.29±0.31,P=0.00)。而术后12个月Mc Goon比无明显增长,术后24个月与术后12个月比较(1.19±0.32 vs.1.22±0.31,P=0.14)以及术后36个月与24个月比较(1.23±0.20 vs.1.22±0.23,P=0.45)差异均无统计学意义。术后6个月内左心室舒张期末容积指数(LVEDVI)增长显著[术前(29.60±10.12)ml/m2 vs.6个月(49.18±11.57)ml/m2,P=0.00],6个月后无明显增长;改良BT分流术后左心室射血分数无明显下降。结论改良BT分流术在12个月内可显著促进法洛四联症患者Mc Goon比增长,12个月后Mc Goon比无明显增长。改良BT分流术在6个月内可显著促进左心室发育,而6个月后延长随访时间并不会导致左心室的过度扩张,对法洛四联症患者心功能影响较小。
Objective To analyze the mid-term efficacy of modified tetralogy of Fallot in patients with tetralogy of Fallot. Methods The clinical data of 69 cases of tetralogy of Fallot with modified BT shunt from Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from July 2006 to January 2013 were retrospectively analyzed. There were 44 males and 25 females, and the operative age was 2 Months to 10 years old, with an average of (17.97 ± 24.73) months; weight ranged from 4 to 24 (9.00 ± 4.03) kg. All patients underwent subclavian-to-pulmonary shunt via right or left posterolateral incision. Results The patients were followed up for 6 to 36 months. Among them, 57 patients were followed up for 6 months and 33 patients were followed up for 6 months and 12 months. At the same time, 16 patients were followed up for 12 months and 24 months, and 24 patients Month and 36 months follow-up in 11 cases. The Mc Goon ratio increased significantly in patients with tetralogy of Fallot over 12 months of modified BT shunting. Mc Goon increased significantly at 6 months (1.40 ± 0.40 vs.1.09 ± 0.33, P = 0.00) Mc Goon showed a significant increase in Mc Goon ratio at 6 months after operation (1.36 ± 0.33 vs.1.29 ± 0.31, P = 0.00) after 12 months. However, Mc Goon had no significant increase at 12 months postoperatively compared with 24 months postoperatively compared with 12 months postoperatively (1.19 ± 0.32 vs.1.22 ± 0.31, P = 0.14) and postoperative 36 months (1.23 ± 0.20 vs.1.22 ± 0.23, P = 0.45), there was no significant difference. Left ventricular end-diastolic volume index (LVEDVI) increased significantly within 6 months after surgery (preoperative 29.60 ± 10.12 ml / m2 vs. 6 months 49.18 ± 11.57 ml / m2, P = 0.00), 6 months No significant increase after; improved BT shunt left ventricular ejection fraction no significant decline. Conclusions Modified BT shunt can significantly increase Mc Goon ratio in patients with tetralogy of Fallot within 12 months and no significant increase in Mc Goon ratio after 12 months. Improved BT shunt within 6 months can significantly promote left ventricular development, and 6 months after the extension of follow-up time will not lead to excessive expansion of the left ventricle, tetralogy of Fallot heart function less affected.