食道超声监测经皮卵圆孔未闭封堵术治疗偏头痛疗效观察  

Percutaneous femoral vein closure of patent foramen ovale in treatment of migraine

作　　者：王庆欣[1] 张秀辉[1] 张玉春[1] 李勇[1] 刘薇[1] 庞广辉[1] 马洪亮[1] 孙念梓 

机构地区：[1]山东省临沂市人民医院心外科,276003

出　　处：《中华解剖与临床杂志》2017年第5期397-401,共5页Chinese Journal of Anatomy and Clinics

摘　　要：目的 探讨单纯食道超声监测经皮股静脉卵圆孔未闭（PFO）封堵术治疗PFO合并偏头痛的疗效和安全性.方法 对2014年1月—2016年6月临沂市人民医院心外科经超声心动图及经颅多普勒（TCD）发泡试验诊断为PFO的15例偏头痛患者的临床资料进行回顾分析.其中男4例、女11例,年龄16~56岁;PFO大小（4.1±0.4）mm,头痛影响测定-6（HIT-6）评分（64.13±3.20）分,心功能正常.均采用单纯食道超声监测下经皮股静脉置入卵圆孔未闭封堵器治疗.观察并对比手术前后残余分流及HIT-6评分,观察患者围术期并发症.结果 15例卵圆孔未闭均封堵成功,食道超声监测卵圆孔水平无残余分流,封堵伞牢固,周围结构无影响.手术时间5~20 min,平均（12.40±4.91）min;住院时间（1.6±0.8）d.术后随访6~18个月,平均12个月.术后1、3、6个月HIT-6评分分别为（52.13±1.92）、（41.47±2.26）和（41.93±1.87）分,与术前相比差异均有统计学意义（t=15.022、21.322、27.546,P值均〈0.05）.术后1、3、6个月经胸超声心动图检查及TCD发泡实验,结果显示15例患者术后3、6个月均无分流.术后随访无严重并发症发生,无封堵器脱落,无血栓或栓塞发生,无心包积液、心律失常、感染性心内膜炎;股静脉穿刺处无感染、血肿、股动静脉瘘等情况发生.结论 单纯食道超声监测经皮股静脉封堵卵圆孔未闭治疗偏头痛,微创、简便、安全,术后恢复快,近期疗效满意.Objective To investigate the feasibility and safety of percutaneous femoral vein closed patent foramen ovale in treatment of migraine monitored only by transesophageal echocardiography and evaluate the therapeutic effect. Methods From January 2014 to June 2016, the data of 15 patients diagnosed by echocardiography and transcranial Doppler （TCD） foaming test as patent foramen ovale（PFO） with migraine（4 patients male, 11 patients female） were retrospectively analyzed. PFO size was （4. 1 ± 0. 4） mm, headache impact score （HIT-6） was 64. 13 ± 3. 20, aged from 16 to 56 years old, the cardiac function was normal. All of the PFO were closed by PFO occluder device through percutaneous femoral vein under the monitoring of transesophageal echocardiography. The residual shunt and HIT-6 score were observed and compared before and after surgery, perioperative complications were also observed. Results Fifteen patients of patent foramen ovale were successfully closed, and no residual shunt was found in the level of the foramen ovale, which had no effect on the surrounding structure. The operation time was 5 - 20 min, average （12. 40 ± 4. 91） min; hospitalization time was （1. 6 ± 0. 8） d. Postoperative follow-up of 6 to 18 months, average of 12 months. one, three and six months postoperatively, HIT-6 scores were 52. 13 ± 1. 92, 41. 47 ± 2. 26 and 41. 93 ± 1. 87 , significantly lower than the preoperative HIT-6 score （ t = 15. 022, 21. 322, 27. 546, all P values were 〈 0. 05）, which were statistical difference. The residual shunt was evaluated in patients with 1, 3, 6 months after operation. The results showed that there was no shunt in 3, 6 months after operation in 15 patients. Postoperative follow-up, no serious complications occurred in the heart, no residual shunt, no occluder detachment, no thrombosis or embolism, no pericardial effusion, no arrhythmia, no infective endocarditis were occurred; There were no infection, hematoma and femoral arteriovenous fistula in femoral vein punctur

关 键 词：偏头痛 卵圆孔 未闭 超声心动描记术 经食管 封堵术 

分 类 号：R654.2[医药卫生—外科学] R747.2[医药卫生—临床医学]