食管超声引导下经左侧胸骨旁肋间小切口封堵小儿干下型室间隔缺损  

Doubly committed ventricular septal defect closure through a left parasternal intercostal minimal incision under transesophageal echocardiography guidance in children

作　　者：俞劲[1] 张泽伟[2] 叶菁菁[1] 李建华[2] 马良龙[2] 石卓[2] 杨秀珍[1] Yu Jin;Zhang Zewei;Ye Jingjing;Li Jianhua;Ma Lianglong;Shi Zhuo;Yang Xiuzhen(Department of Echocardiogra ph y,Heart Cente;Department of Cardiac Surgery ＆ Heart Center,Children＇s Hospital,Zhejiang University School of Medicine,Hang zhou 310052,China)

机构地区：[1]浙江大学医学院附属儿童医院心脏中心超声科,杭州310052 [2]浙江大学医学院附属儿童医院心脏中心心外科,杭州310052

出　　处：《中华小儿外科杂志》2018年第8期589-593,共5页Chinese Journal of Pediatric Surgery

基　　金：浙江省教育厅一般科研项目（Y201636526）

摘　　要：目的本研究评估食管超声心动图（TEE）引导下经左侧胸骨旁肋间小切口封堵小儿干下型室间隔缺损（DCVSD）的价值。方法2014年8月至2016月12月间，40例DCVSD患儿经单纯TEE引导下采用左侧胸骨旁肋间小切口（≤1 cm）及心包悬吊技术行DCVSD封堵术。TEE引导及监测封堵全过程，术后定期随访评估封堵效果。 结果40例DCVSD患儿成功封堵39例，手术成功率为97.5%。室间隔缺损大小为（3.59±0.92） mm，偏心伞封堵器型号为（5.33±1.40） mm，手术时间（45.04±12.81）min。术后随访时间为6～24个月。术前发现DCVSD合并轻度主动脉瓣右冠瓣脱垂（AoVP）和（或）轻度主动脉瓣反流（AR）患儿7例，术后AR好转1例，另外无变化。成功封堵的39例均无围手术期死亡，无封堵器变形移位，无残余分流，无完全性房室传导阻滞，无瓣膜影响。2例术后少量心包积液，随访中消失。1例因封堵后仍有较明显分流中转体外循环下DCVSD修补术。结论TEE引导下经左侧胸骨旁肋间小切口行小儿DCVSD封堵术安全有效，无需切胸骨，并发症发生率低，手术切口小，而且能够准确定位，操作简单。ObjectiveTo explore the value of doubly committed ventricular septal defect （DCVSD） closure through a left parasternal intercostal minimal incision under transesophageal echocardiography （TEE） guidance in children.MethodsBetween August 2014 and December 2016, 40 DCVSD children were recruited. The lesions were closed through a left parasternal intercostal minimal incision （≤1 cm） and pericardium hanging technique under TEE guidance. TEE was employed for guiding and monitoring the whole procedure. The effectiveness of device closure was assessed by postoperative regular follow-up.ResultsAmong them, 39 children underwent complete closure with an operative success rate of 97.5%. The average size of DCVSDs was 3.59±0.92 （2.2-6.0） mm, the average device size 5.33±1.40 （4-9） mm and the average operative duration 45.04±12.81 （18-70） min. Postoperative follow-up period lasted from 6 to 24 months. Seven cases with mild aortic valve prolapse （AoVP） and/or mild aortic regurgitation （AR） were detected preoperatively and pre-existing AR disappeared postoperatively in one patient and remained unchanged in another. There were no cases of perioperative mortality, device deformation or displacement, residual shunt, complete atrioventricular block or valve involvement. Mild pericardial effusion in two patients disappeared during a follow-up period of 3 months. One patient was converted into repairing under direct visualization with a cardiopulmonary bypass because of obvious residual shunt around the occluder.ConclusionsClosing DCVSDs through a left parasternal intercostal minimal incsion under TEE guidance in children has the following advantages： avoidance of radiation and sternum incision, procedural reliability and safety, definite efficacy, lower complication rate, minimal incision and simple handling. Wider application of this procedure is recommended.

关 键 词：超声心动描记术 经食管 室间隔缺损 动脉干 外科手术 微创性 心脏外科手术 儿童 

分 类 号：R726.5[医药卫生—儿科]