经胸微创封堵术治疗婴幼儿室间隔缺损的疗效评价  

Evaluation of the efficacy of transcatheter closure of ventricular septal defect in infants and young children

作　　者：宋毅[1] 钟前进[1] 陈建明[1] 李志平[1] 李福平[1] 胡义杰[1] 

机构地区：[1]第三军医大学大坪医院野战外科研究所心血管外科,重庆400042

出　　处：《中国处方药》2015年第11期4-5,共2页Journal of China Prescription Drug

摘　　要：目的：探讨经胸微创婴幼儿室间隔缺损封堵术治疗效果，探讨其临床应用价值。方法室间隔缺损的患儿50例，彩超明确室间隔缺损情况，选取相应的封堵器型号备用，在全麻、气管插管下进行手术，经口腔插入食道超声探头，胸骨正中作上至第三肋间水平下至剑突3～4 cm 的小切口，显露右心室，食道超声配合封堵器封室间隔缺，膜部室间隔缺损选择封堵器直径应较缺损直径大0～2 mm，伴膜部瘤者封堵器直径应较缺损直径大3～4 mm。术后常规肝素抗凝及口服阿司匹林抗凝。结果手术时间（62.23±11.23）min，全部封堵成功，食道超声显示封堵器与室间隔缺损边缘吻合紧密无残余分流，未出现主动脉瓣、二尖瓣和三尖瓣反流。住院（9.11±1.84）d。术后随访（24.11±6.42）个月，所有随访到患者均无封堵器脱落、感染性心内膜炎、血栓栓塞、猝死等严重并发症发生。结论经胸微创封堵是治疗室间隔缺损的有效方法，在婴幼儿期先天室间隔缺损矫治术取得了较好的效果，值得临床应用。Objective To investigate the therapeutic effect of transcatheter closure of ventricular septal defect in infants oryoung children with minimally invasive surgery,and to explore the clinical application value. Methods 50 cases of children with ventricular septal defect were confirm by Colour Doppler Ultrasound. Then selected the appropriate occluder type spare and had an operation under general anesthesia and tracheal intubation.The transesophageal echocardiography probe is inserted through the mouth. Exposed the right ventricle with 3 ~ 4 cm small incision from the xiphoid to the third intercostal level on median sternotomy. And the transesophageal echocardiography was used for occluder closure of ventricular septal defect. In addition,Membranous ventricular septal defect choose occluder diameter larger than the defect diameter of 0 ~ 2 mm; with membranous aneurysm,the selection of the occluder diameter should be 3 ~ 4 mm larger than the diameter of the defect. Conventional heparin anticoagulation and oral aspirin anticoagulation were used after the surgery. Results The Operation time was（62.23±11.23）min. All the closures were successful with no residual shunt and no regurgitation in the aortic valve,mitral valve and tricuspid valve. And the Hospitalization were（9.11±1.84）days. Postoperative follow-up was（24.11±6.42）months; all follow-up to the patients,there were no occluder detachment,infective endocarditis,thromboembolism,sudden death and other serious complications occurred. Conclusion Minimally invasive closure is an effective method for the treatment of ventricular septal defect in infants and young children.

关 键 词：微创 婴幼儿 室间隔缺损 封堵术 

分 类 号：R726.5[医药卫生—儿科]