介入治疗疑难动脉导管未闭的临床研究  

Transcatheter occlusion of difficult patent ductus arteriosus:a clinical research

作　　者：王永武[1] 李钦传[1] 冯靖[1] 孙益峰[1] 蔡建志[1] 沈炯[1] 

机构地区：[1]同济大学附属同济医院心胸外科,上海200065

出　　处：《中华心血管病杂志》2002年第10期607-609,共3页Chinese Journal of Cardiology

基　　金：本课题由国家自然科学基金资助 (编号 :3 9870 2 0 9);上海市科委基金资助 (编号 9741190 2 8);法国卫生部重点课题 (中法交流课题 )

摘　　要：目的　介绍利用改良Porstmann方法和带阀门内支架 (WYW方法 )介入治疗疑难动脉导管未闭 (PDA)的临床应用经验。方法　 172例PDA患者 ,女性 134例 ,男性 38例 ;年龄 3～ 6 2岁 ,平均2 5岁 ;3～ 12岁 5 8例 ,13～ 6 2岁 114例。降主动脉造影显示PDA内径 (最狭处 ) 1 4～ 13 3mm ,平均5 6mm。PDA形态 :漏斗型 16例、管型 10 9例、乳头型 30例、窗型 5例、PDA结扎术后再通 12例 (其中 2例为两次结扎术后再通 ,1例为体外循环下缝扎术后再通 )。其中属疑难PDA范畴共计 6 7例 (39% ) ,应用改良Porstmann方法堵闭PDA 4 4例 ,WYW方法堵闭PDA2 2例 ,SpiralCoil方法堵闭 1例。结果用WYW方法一次堵闭成功率为 97% (共 37例 )。即刻PDA造影显示无残余分流 ,术后第一天 ,检查胸部正侧位片 ,见支架固定良好 ,出院前超声心动图检查无残余分流 ,随访 1～ 6 4个月 ,无一例再通 ,恢复良好。结论　用改良Porstmann法和WYW方法治疗疑难PDA ,该技术及其装置可靠、有效 ,简化了手术 ,可堵闭各种类型的PDA ,尤其适用于疑难的PDA ,值得临床的推广应用。Objective To elucidate the clinical effect on occlusion of the difficult patent ductus arteriosus (PDA) with amendeded Porstmann way and WYW way Methods PDA were diagnosed in 170 patients Females and males were 133 and 37 cases respectively Age ranged from 3 to 62 years old The characteristics of morphology were divided into funnel type in 16, tubular type in 108, nipple type in 29, window type in 5, and reopen after surgical occlusion in 12 (including 2 cases reopen after two times surgical occlusion and 1 case reopened after sutured PDA under CPB) 67 cases were difficult PDA treated by transcatheter closure, among whom 44 cases were closed with amended Porstmann device and 22 cases with WYW occlusion device and 1 case with Spiral Coil The stent with valve was delivered to PDA by catheter through femoral artery to close it Results There were no residual shunts in all patients closed by WYW occlusion device examined by echocardiography and cineangiography after the procedure Followed up 4 63 months, all patients recovered satisfactorily Conclusion The successfully clinical usage of WYW occlusin device in patients with difficult PDA demonstrated that the stent shoud be reliable, effective and hopeful to be used in all kinds of PDA

关 键 词：介入治疗 动脉导管未闭 堵闭 带阀门内支架 PDA 

分 类 号：R541.1[医药卫生—心血管疾病]