成人室间隔肌部大缺损的手术治疗  

Surgical Treatment of Large Muscular Ventricular Septal Defect In Adults

作　　者：赵东[1] 王春生[1] 周达新[1] 朱仕杰[1] 过常发[1] 

机构地区：[1]复旦大学附属中山医院心外科,上海市心血管病研究所,上海200032

出　　处：《中国临床医学》2013年第4期493-495,共3页Chinese Journal of Clinical Medicine

摘　　要：目的:探讨成人室间隔肌部大缺损患者的外科手术治疗方法及可能出现的术后并发症,寻找最佳治疗方案并减少术后并发症发生率。方法:回顾分析2008年10月—2012年2月6例成人室间隔肌部大缺损患者的手术过程,其中2例行导管介入下室缺封堵术,2例行体外循环下室缺修补术,另外2例为外伤性室间隔损伤,行修补手术。结果:6例患者均存活,其中3例出现不同程度的房室传导阻滞,1例术后出现残余分流,再次予以导管介入下室缺残余漏封堵术,1例外伤性室间隔撕裂修补术后再次撕裂,二次手术重新修补。结论:成人室间隔肌部大缺损是一类较为罕见的疾病,治疗方法首选导管介入下室缺封堵术,如必须行室缺修补术的患者,则尽量避免切开左心室,注意室缺的边缘及传导束的走向,减少术后并发症的发生。Objective：To explore the surgical treatment stratagies of large muscular ventricular septal defect（VSD）and its possible postoperative complications,and to find out the best surgical treatment of large muscular VSD to reduce the postoperative complications.Methods：Six adult patients of large muscular VSD who received surgical treatment from October 2008 to February 2012 were retrospectively analysed.Two patients used the VSD Amplatzer occluder through catheter,two patients received VSD repair under cardiopulmonary bypass,and the two cases of traumatic VSD were treated by complicated VSD repair.Results：All the six patients survived.Three of them had artrial-ventricular conduction block,one had residual VSD,and a residual shunt under catheterization was performed again.And the one who had traumatic VSD accepted a second successful VSD repair.Conclusions：Large muscular VSD is a kind of relatively uncommon disease.The first choice to treat large muscular VSD was Amplatzer occluding device through catheter.To avoid the left ventriculotomy is the main surgical point,if VSD repair is necessary.Meanwhile,care should be taken to the range of VSD to reduce the postoperative complications.

关 键 词：室间隔肌部大缺损 成人 手术治疗 

分 类 号：R654.3[医药卫生—外科学]