经胸小切口封堵术与外科手术治疗膜部室间隔缺损的对比研究  

Comparative study on treatment of perimembrane ventricular septal defects by the chest small incision closure of VSD and by surgical repair

作　　者：杨新超[1] 柳德斌[2] 王炜[2] 

机构地区：[1]兰州大学第一医院心外科,甘肃省兰州市730000 [2]兰州大学第二医院心外科

出　　处：《中国心血管病研究》2014年第4期323-326,383,共5页Chinese Journal of Cardiovascular Research

摘　　要：目的 探讨经胸小切口封堵术治疗膜部室间隔缺损（VSD）的优势及临床应用价值.方法 自2011年9月至2013年2月,选择40例经胸小切口封堵术治疗膜部VSD的患者,另外选40例经传统外科修补术治疗膜部VSD的患者.两组患者年龄1～32（15.5±3.5）岁,体重10.8～58.0（24.2±7.5）kg,膜部室间隔缺损大小为2～14（5.6±0.5）mm.分别依据两种不同的方法完成手术,比较两组的疗效、并发症及其他相关因素,评估经胸小切口封堵术的可行性及优越性.结果 经胸小切口封堵术组有1例患者封堵失败,行开胸手术治疗,成功率97.5％;外科手术组除1例因急性感染死亡外,余全部手术成功.两组治疗成功率相似,但在术后并发症及其他相关因素方面有明显差别.术后3～12个月随访,经胸小切口组无新并发症出现,而外科组新出现一系列并发症.结论 尽管经胸小切口膜部VSD封堵术较外科手术治疗效果相当,但具有术后并发症较少、恢复快、创伤小、患者易于接受等优点.目前该技术是可行的,且临床应用价值高.Objective To discuss the advantages of device closure via a small lower sterna] incision of perimembrane VSD and the clinical application value,constantly summarize the clinical experiences.Methods Between September 2011 and February 2013,40 patients who underwent closure via a small lower sternal incision and another 40 patients who underwent the conventional surgical repair of perimembrane VSD were collected,aged 12 months to 32 years （15.5±3.5）years old with a body weight of 10.8-58.0（24.2±7.5）kg,the size of perimembrane VSD was 2-14（5.6±0.5）mm.Assessing the superiority and feasibility of closure via a small lower sternal incision by comparing with each other.Results The small incision group was successful in all patients,except for 1 patient who required immediate surgical conversion after the operation failed （97.5％）.The surgical group：all patients are successful in 40 patients except one patient died of acute infection.The success rate of device closure was similar to the surgical repair.However,there were many significant differences in complications and other related factors.In a follow-up period of 3 to 12 months there was no new complications in the small incision group,but surgical group appeared lots of new complications.Conclusion Though the success rate of device closure is similar to the surgical repair,but the recovery time,complications,trauma to the vessels and other relevant factors decrease.At present,this technique is feasible,its clinical application value is quite high and the patients are easy to accept it.

关 键 词：食管超声心动图 小切口 膜部室间隔缺损 

分 类 号：R654.2[医药卫生—外科学]