介入封堵术与外科手术治疗膜周部室间隔缺损效果的观察  

Treatment of perimenbranous ventricular septal defect-transcatheter occlution vs surgery

作　　者：区曦[1] 张智伟[1] 钱明阳[1] 王慧深[1] 李渝芬[1] 石继军[1] 王树水[1] 李俊杰[1] 谢育梅[1] 

机构地区：[1]广东省人民医院心血管病研究所心儿科,510100

出　　处：《中国介入心脏病学杂志》2005年第2期94-96,共3页Chinese Journal of Interventional Cardiology

摘　　要：目的　探讨介入封堵术对膜周部室间隔缺损的即时治疗效果,并与同期外科手术效果进行对比。方法　采用封堵术治疗膜周部室间隔缺损患儿4 8例,与同一时期采用外科手术治疗的73例患儿,进行年龄、身高、体重、肺动脉压力、室间隔缺损大小、手术及住院时间、手术成功率及并发症的比较。两组间均数的比较采用t检验,率的比较采用卡方检验。结果　两组小儿的年龄、身高、体重、肺动脉压力及手术成功率差异无统计学意义。封堵术组的室间隔缺损较手术组的小,但手术及住院时间较短。封堵组术中及术后出现左前分支或完全性左束支阻滞较多见,其他并发症包括再次外科手术、残余分流、术中出血多、神经受损、溶血、术中或术后Ⅲ度房室传导阻滞、气胸、胸腔积液、心包积液、主动脉关闭不全及术后感染在两组间差异无统计学意义。结论　室间隔缺损封堵术作为治疗室间隔缺损的新方法,即时的疗效确切。采用封堵术治疗室间隔缺损应遵循治疗原则,术中遵守操作规范,术后严密观察,从而减少并发症的发生。Objective To evaluate the therapeutic effect of transcatheter closure of perimenbranous ventricular septal defect (PMVSD) with membranous VSD occluder device and compare the effect of transcatheter closure of VSD with surgery. Methods The therapeutic effect of transcatheter occlusion in 48 children with VSD is compared with that of other 73 cases who had received surgical treatment. Age, height, weight, pulmmary artery pressure, size of the defect, time for hospitalization, success rate as well as complications after operations are compared between the 2 groups. All the data are proccessed either by means of t test or χ 2 test statistically. Results There are no statistical differences between the two groups in age, height, weight, pulmonary systolic pressure and the rate of success. But the size of VSD is smaller and the time for operation and hospitalization is shorter in the group of transcatheter occlusion. There are no significant differences between the two groups in the rate of complications including the second surgery, residual shunt, bleeding, nerve injury, hemolysis, Ⅲ atrioventricular block, pneumothorax, hydrothorax, hydropericardium, aortic valve insufficiency and infection. But left anterior bundle branch block and complete left bundle branch block occur more often in the group of the catheter interventions during or after the occlusion. Conclusion Transcatheter occlusion shows a promising therapeutic effect on VSD. To prevent complications, therapeutic rules and technical criterias should be obeyed and close monitoring after the closure should be carried out.

关 键 词：膜周部室间隔缺损 外科手术治疗 介入封堵术 完全性左束支阻滞 Ⅲ度房室传导阻滞 室间隔缺损封堵术 主动脉关闭不全 肺动脉压力 住院时间 手术成功率 并发症 治疗效果 手术效果 卡方检验 左前分支 残余分流 术中出血 神经受损 

分 类 号：R654.2[医药卫生—外科学] R541.76[医药卫生—临床医学]