膜部室间隔缺损微创手术封堵初步经验总结  

Preliminary surgical experience of minimally invasive device closure of perimembranous ventricular septal defects

作　　者：王顺民 徐志伟[1] 刘锦纷[1] 严勤[1] 张海波[1] 郑景浩[1] 鲁亚南 祝忠群[1] 苏肇伉[1] 丁文祥[1] 

机构地区：[1]上海交通大学医学院附属上海儿童医学中心心胸外科,上海200127

出　　处：《上海交通大学学报（医学版）》2013年第1期62-66,共5页Journal of Shanghai Jiao tong University:Medical Science

摘　　要：目的总结通过微创手术经心室行膜部室间隔缺损(VSD)伞片封堵的临床经验,探讨该技术的手术方法和适应证。方法对48例膜部VSD患儿采用胸下小切口经心室途径封堵治疗。患儿均为膜周限制性VSD,VSD基底部直径2～9 mm;伞腰直径4～10 mm;45例采用同心伞,3例采用偏心伞。在经食管超声心动图的引导下经右心室放入室间隔封堵伞。结果 45例患儿术后心功能稳定,随访1～6个月,伞片位置无移位,无心律失常和残余分流。其余3例患儿发生心律失常,其中1例发生室性早搏和短阵性室性心动过速,2例发生房室传导阻滞,经治疗均好转。结论经胸小切口行伞片封堵膜部VSD为VSD的治疗提供了一种良好的选择,应严格把握手术适应证。Objective To summarize the clinical experience of minimally invasive perventricular device closure of perimembranous ventricular septal defects （VSD）, and explore the surgical techniques and indications. Methods Forty- eight patients with perimembranous VSD underwent perventricular device closure with inferior sternotomy. Restrictive perimembranous VSD were found in all the patients. The basal diameters of VSD ranged between 2 mm and 9 mm, and the diameters of the occlusion device waist ranged between 4 mm and 10 mm. Concentric occluders were used in 45 patients, and eccentric occluders were used in 3 patients. The occlusion device was deployed through right ventricle under echocardiographic guidance. Results Forty-five patients were stable in heart function after operation. Patients were followed up for 1 to 6 months, and there was no position shift of the occlusion devices, arrhythmia or residual shunt. Arrhythmia occurred in the other 3 patients after operation, including ventricular premature beat in 1 patient and atrioventricular block in the other 2 patients. All of these three patients recovered after treatment. Conclusion The perventricular device closure of perimembranous SD with inferior sternotomy appears to be a favorable choice for the treatment of VSD, while the surgical indications should be carefully managed.

关 键 词：室间隔缺损 微创 手术 

分 类 号：R726.5[医药卫生—儿科]