单纯经胸超声心动图引导下经皮动脉导管未闭ADOⅡ封堵术的单中心临床研究  

Summary of treatment experience of percutaneous ADOⅡ closure for pediatric patent ductus arteriosus under simple transthoracic echocardiography

作　　者：张庆[1] 吴奇 杨帅 叶菁菁[1] 杨秀珍[1] 俞劲[1] 徐玮泽[1] Zhang Qing;Wu Qi;Yang Shuai;Ye Jingjing;Yang Xiuzhen;Yu Jin;Xu Weize(The Heart Center,Children's Hospital of Zhejiang University School of Medicine,National Clinical Research Center for Child Health,Hangzhou,310052,China;Department of pediatrics,Dongyang women and Children's Hospital,Dongyang,322100,China)

机构地区：[1]浙江大学医学院附属儿童医院心脏中心,国家儿童健康与疾病临床医学研究中心,浙江省杭州市3100052 [2]东阳市妇女儿童医院儿科,浙江省东阳市322100

出　　处：《临床小儿外科杂志》2019年第9期763-766,共4页Journal of Clinical Pediatric Surgery

基　　金：浙江省科技厅国际科技合作高技术产业联合研发项目(编号:2016C54006)

摘　　要：目的总结以经胸超声心动图(transthoracic echocardiography,TTE)作为唯一影像学工具,并应用ADOⅡ封堵器开展动脉导管未闭(patent ductus arteriosus,PDA)封堵术的临床治疗经验。方法以2018年7月至2019年6月浙江大学医学院附属儿童医院收治的68例于单纯TTE下行PDA封堵术的患儿为研究对象,其中男38例,女30例,平均月龄(29.35±16.52)个月,平均体重(13.09±4.19)kg。术前通过TTE测量PDA的主动脉端内径、肺动脉端内径、最细处内径及PDA长度,并根据测量结果选择合适的封堵器。术中采用股动脉径入路,于单纯TTE引导下监测PDAADOⅡ封堵术的全过程。术后1d即开始进行病情观察,门诊随访1~6个月。结果68例PDA肺动脉端平均开口直径(2.38±0.97)mm,主动脉端平均开口直径(4.48±2.70)mm,PDA平均长度(5.37±1.42)mm。ADOⅡ平均大小(4.46±1.20)mm,平均长度(4.38±0.79)mm,其中管型27例,漏斗形41例。64例在TTE引导下成功完成经皮PDA封堵术,平均手术时间(11.16±5.18)min;4例中转为X线引导下经皮PDA封堵术。术后平均住院时间(3.24±1.24)d,平均住院费用(23732.20±1686.02)元。术后门诊随访1~6个月,无一例出现封堵器移位、残余分流、肺动脉和主动脉流速增快、上下肢血压反常、瓣膜损伤、心包积液、机械性溶血、外周血管损害等并发症。结论单纯TTE引导下,应用ADOⅡ经皮封堵婴幼儿PDA的可行性和成功率均较高,同时能够避免X线及造影剂造成的副反应,但对于肺动脉开口细小的PDA则需要做好传统介入封堵术预案。Objective To summarize the clinical experiences of transthoracic echocardiography (TTE) as a sole imaging tool and the application of ADOⅡ occluder for patent ductus arteriosus (PDA). Methods A retrospective analysis was performed for 68 children undergoing PDA closure under TTE from July 20,2019 to June 2019.There were 38 boys and 30 girls with an average age of (29.35±16.52) months and an average body weight of (13.09±4.19) kg.The aortic end of PDA,the inner diameter of pulmonary artery,the innermost diameter of apex and the length of PDA were measured by TTE pre-operation and a suitable occluder was selected according to the measurements.Intraoperative femoral artery access was employed for monitoring the whole process of PDA ADOⅡ closure under TTE guidance.Observations were made at 1 day post-operation and the follow-up period was 1 to 6 months. Results The average opening diameter of pulmonary artery end was (2.38±0.97) mm,the average opening diameter of aortic end (4.48±2.70) mm and the average length of PDA 5.37±1.42 mm.The average size of ADOⅡ was (4.46±1.20) mm and the average length (4.38±0.79) mm,including 27 cases of tube type and 41 cases of funnel shape.All 64 patients underwent percutaneous PDA occlusion under the guidance of TTE.The average operative duration was (11.16±5.18) min.Four patients underwent X-ray guided percutaneous PDA occlusion.The average postoperative hospital stay was (3.24 ±1.24) days,the average hospitalization cost (23732.20±1686.02) yuan and the follow-up period 1 to 6 months.There was no instance of occluder displacement,residual shunt or pulmonary artery and aortic flow rate increase,upper/lower limb blood pressure abnormalities,valve damage,pericardial effusion,mechanical hemolysis,peripheral vascular damage or other complications. Conclusion Under the guidance of TTE alone,the feasibility and success rate of ADOⅡ percutaneous closure of infantile PDA are high so that radiography and contrast agent may be avoided.For PDAs with small pulmonary opening,an i

关 键 词：超声心动描记术 经胸 动脉导管未闭 封堵术 ADOⅡ封堵器 儿童 

分 类 号：R726[医药卫生—儿科] R540.45[医药卫生—临床医学]