小儿室缺伴主动脉瓣关闭不全的外科疗效分析  

Ventricular Septal Defect Associated with Aortic Valve Insufficiency in Children:Analysis of Surgical Results and the Correlated Factors Affecting Prognosis

作　　者：邢泉生[1] 张善通[1] 陈张根[1] 曹金红[1] 王人荣[1] 贾兵[1] 

机构地区：[1]上海医科大学儿科医院心胸外科

出　　处：《中华胸心血管外科杂志》1998年第2期71-73,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：总结小儿室间隔缺损（ＶＳＤ）伴主动脉瓣关闭不全（ＡＩ）的外科治疗效果及其影响因素。随访８２例ＶＳＤ伴ＡＩ病儿的诊治和预后情况，并对多种影响因素进行ｔ检验及多元线性回归分析。结果显示，小儿ＶＳＤ合并ＡＩ发生率约为７．０７％，其中干下型ＶＳＤ伴ＡＩ占总数的１９．５８％；膜周型为４．１８％。本组８２例中６４例单纯行ＶＳＤ修补术，１８例行ＶＳＤ修补加主动脉瓣成形术。术后随访５个月～１２年，无并发症，无近远期死亡，残余反流无１例较术前加重。结论：ＡＩ的程度、ＶＳＤ类型及术前心胸比率等对选择手术方法有指导意义。Aim:This retrospective study was conducted to evaluate the results of surgical treatment of ventricular septal defect(VSD)associated with aortic valve insufficiency(AI)in children and to explore the correlated factors affecting the prognosis.Clinical material and method:Of 880 patients with VSD treated in our hospital,68 patients(7.73%)were associated with AI.There were 38 boys and 30 girls with a mean age of 5.4 years (range,9 months to 12 years).Diagnosis was made by echocardiogram.According to Seller's classification,AI was mild in 55 patients,moderate in 11 and severe in 2.Supracristal defect was present in 41 patients and membranous defect in 27.Surgical repair of VSD was performed in 55 patients with mild AI,and combined closure of VSD and aortic valvaloplasty were done in 13 patients with moderate to severe AI.Results:There was no postoperative mortality.Postoperative residual AI was noticed in 10 patients(mild in 6 and moderate in 4).In the 6 month to 10 year follow up,there were no early or late deaths and no aggravation of residual AI.The mean cardiac to thoracic ratio was significantly reduced from 0.58±0.06 to 0.52±0.02(P<0.01).Postoperative echocardiogram study revealed that the mean pressure gradient across aortic valve markedly decreased from 67.5±16.9mmHg to 40.3±23.2mmHg(P<0.01).Conclusion:The results of this study suggested that severity of AI and type of VSD,affect the choice of surgical technique and effectiveness of aortic valvuloplasty.

关 键 词：室间隔缺损 主动脉瓣 关闭不全 儿童 外科手术 

分 类 号：R726.542[医药卫生—儿科]