肌部室间隔缺损的个性化治疗  

lndividualized treatment of muscular ventricular septal defect

作　　者：顾海涛 顾群 周洁 陆小虎 陆凤霞 张永生 张斯璧 王怡悦 袁洪梁 

机构地区：[1]南京医科大学第一附属医院,江苏省人民医院小儿心胸外科,210039

出　　处：《中华小儿外科杂志》2013年第8期574-577,共4页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨肌部室间隔缺损（mVSD）外科纠治方法的选择。方法回顾性分析2009年12月至2012年7月外科治疗54例mVSD患儿的临床资料。8例单纯mVSD行胸壁小切口，食道超声引导下右心室前壁穿刺置入封堵伞关闭mVSD，其余均在体外循环下，经右心房路径修补或封堵mVSD，其中1（）例采取直视下封堵，15例行双层浅表连续缝合心内膜关闭缺损，3例采用自身心包补片修补，18例采用“三明治”技术关闭缺损。伴心内畸形者，行同期纠治。结果术后呼吸功能不全4例，治疗痊愈出院；1例合并重症法乐四联症术后发生低心排，放弃治疗，其余均顺利出院，出院时无显著的室缺残余分流。术后心功能恢复良好，随访1个月至3年，复查心脏彩超示残余缺损4例，直径均小于0．3cm，未处理。结论明确mVSD的病理解剖，结合患儿病情和家庭经济状况，选择合适的纠治方案能明显减少手术并发症和病死率，使患儿获得最优化治疗。Objective To investigate the results of surgical treatment of muscular ventricular septal defect （mVSD）. Methods The records of 54 patients with mVSD from Dec 2009 to July 2（/12 were reviewed, mVSDs were closed with devices under direct vision through a small incision on chest wall under the guidance of transesophageal echocardiography in 8 cases. In the other patients, closure of the mVSDs was through a right atriotomy with cardiopulmonary bypass （CPB）. In these patients, 10 cases used hybrid approach to close the defect, 15 cases had the defect closed directly, pericardial patch was used in 3 cases, 18 cases used ＂sandwich＂ technology to close the defect. Intracardiac malforma tions were corrected at the same time. Results After operation,4 cases had respiratory insufficiency, and 1 case with tetralogy of Fallot died after the operation. The other patients were discharged from hospital without obvious remnant shunt by echocardiography. Cardiac function recovered well. In the follow-up period （1 month to 3 years）, 2 cases had persistent residual shunts and the diameters were less than 3 mm. Conclusions Knowledge of anatomy of mVSD can definitely help choose the appropri- ate treatment so as to decrease complications and mortality.

关 键 词：心脏病 先天性 室间隔缺损 心脏外科手术 

分 类 号：R726.5[医药卫生—儿科]