经导管堵闭与外科手术治疗儿童先天性室间隔缺损疗效及中远期随访  

Efficacy of transcatheter closure versus surgery repair of congenital ventricular septal defect in children: a midand long-term follow-up result

作　　者：夏树亮[1] 张智伟[1] 

机构地区：[1]广东省心血管病研究所心儿科,广州510080

出　　处：《岭南心血管病杂志》2010年第3期185-189,共5页South China Journal of Cardiovascular Diseases

基　　金："十一五"国家科技支撑计划(项目编号:2007BA105B03)

摘　　要：目的比较经导管及外科治疗儿童室间隔缺损(ventricular septal defect,VSD)的疗效、并发症及中远期随访的结果。方法回顾性分析2002年3月至2004年12月广东省人民医院VSD患儿176例的临床资料,根据手术方式不同分为堵闭组(n=114)及外科组(n=62),对疗效、并发症及随访的结果进行对比。结果堵闭组技术成功率96.5%,外科组成功率100%,两组比较,差异无统计学意义(P=0.336)。两组术后第7天:左心室舒张末期内径、二尖瓣血流速度均较术前缩小,外科组差异有统计学意义(P<0.01)。堵闭组三尖瓣反流率较外科组高,差异有统计学意义(P=0.004)。外科组不完全右束支传导阻滞较堵闭组高,差异有统计学意义(P=0.003)。术后3个月:外科组三尖瓣血流速度较术前增加幅度比堵闭组更大,差异有统计学意义(P=0.016),余超声参数、瓣膜并发症两组比较,差异无统计学意义(P>0.05)。术后12个月:外科组右心室舒张末内径较术前增加幅度比堵闭组高,差异有统计学意义(P=0.033),外科组二尖瓣反流率及主动脉瓣反流率较堵闭组高,差异有统计学意义(P<0.05)。术后5年:外科组三尖瓣反流率较堵闭组高,差异有统计学意义(P=0.010),余瓣膜、心律失常并发症两组比较,差异无统计学意义(P>0.05)。生长落后者经两种手术后生长均恢复正常。结论经导管堵闭与外科手术治疗儿童VSD均安全可行、疗效可靠、成功率高,且远期疗效良好。Objectives To compare effectiveness, complication and long-term follow up results of transcatheter occlusion with surgical ventricular septal defect（VSD） closure. Methods A retrospective study was performed in 176 patients with VSD in Guangdong Cardiovascular Insititute from March 2002 to December 2004. The patients were assigned to either the occlusion group（n=ll4） or surgery group（n=62） according to the style of the procedure. This study was done to compare the effectiveness, complications and follow-up of the results of both techniques. Results The closure rate was similar in the 2 groups： 96.5% in occlusion group, 100% in surgical group（P=0.336）. At 7 days after procedure in 2 groups： left ventricular end-diastolic dimension （LVEDd） and mitral valve （MV） blood flow rate both reduced compared with those before procedure, those in the surgery group reduced more significantly （P〈0.01）; According to incidence of tricuspid regurgitation （TR）, higher in occlusion group （P=O.O04）. New incomplete right bundle branch bloek（IRBBB） in surgical group was higher than that in occlusion group（P=0.003）. At 3 months after procedure in 2 groups： increasement of tricuspid valve（TV） blood flow rate in surgical group was higher than that in occlusion group （P=0.016）, there was no significant difference in change range of echocardiography data else and valve complications in the 2 groups （P〉 0.05）. At 12 months after procedure in 2 groups： right ventricular end-diastolic dimension （RVEDd） in surgery group increased more than that in occlusion group （P=0.033）, The rate of aortic regurgitation （AR） and mitral regurgitation（MR） in surgery group were higher than those in occlusion group（P〈0.05）. At 5 yeras after procedure in 2 groups： the rate of TR in surgery group was higher than that in occlusion group（P=0.010）, there was no significant difference in valve complications else and arrhythmia complications in the 2 groups （P〉 0.05）. P

关 键 词：室间隔缺损 导管堵闭 外科修补 随访 

分 类 号：R541.1[医药卫生—心血管疾病]