完全型房室间隔缺损的外科治疗经验  

Experience of surgical treatment of complete atrioventricular septal defect

作　　者：李江振 范太兵 李斌 宋书波 宣茂正 梁栋 Jiang-zhen Li;Tai-bing Fan;Bin Li;Shu-bo Song;Mao-zheng Xuan;Dong Liang(Zhengzhou University People’s Hospital(Henan Provincial People’s Hospital),Zhengzhou,Henan 450003,China)

机构地区：[1]郑州大学人民医院(河南省人民医院),河南郑州450003

出　　处：《中国现代医学杂志》2020年第7期82-86,共5页China Journal of Modern Medicine

基　　金：河南省科技厅重点攻关项目(No:162102310023)。

摘　　要：目的总结完全型房室间隔缺损(CAVSD)的外科手术治疗效果。方法选取2013年4月-2018年4月河南省人民医院CAVSD患儿74例。所有患者术中行房室瓣成形,同期修补合并畸形。结果74例CAVSD患儿中,单片法11例,双片法28例,改良单片法35例。改良单片法与双片法的阻断时间、机械通气时间、ICU驻留时间比较差异有统计学意义(P<0.05),改良单片法短于双片法。术后早期死亡2例,病死率为2.7%。死亡原因:1例因低龄、低体重,术后出现多器官功能衰竭;1例因瓣膜成形效果差,术后出现瓣膜反流、心律失常、低心排综合征;其余患儿均顺利出院。随访72例,随访时间4~33个月,中期随访结果显示二尖瓣轻度反流13例,轻至中度反流4例,3例有1~2mm的VSD残余分流。结论CAVSD肺血管病变较早,应早期诊断和手术治疗,个体化的手术方案可以提高手术矫治效果。手术成功的关键是妥善处理房室瓣,避免术中房室传导阻滞及术后肺动脉高压危象。Objective To summarize the surgical treatment of complete atrioventricular septal defect(CAVSD).Methods From April 2013 to April 2018,74 patients with complete atrioventricular septal defect(CAVSD)were treated.All patients underwent atrioventricular valvuloplasty with repairation of deformity during the operation.Results Among the 74 CAVSD patients,there were 11 patients with single tablet method,28 patients with double tablet method and 35 patients with improved single tablet method.The pairwise comparison of the three surgical methods showed that there were significant differences in block time,mechanical ventilation time,and ICU stay time between the modified single-slice method and the double-slice method(P<0.05).The time of all three variables was shorter than that of the double-slice method(P<0.05).2 patients died early after operation,and the mortality rate was 2.7%.The cause of death:one case had multiple organ failure due to young age and low body weight;one had arrhythmia,and low cardiac output syndrome due to poor valvuloplasty;the rest of the children were discharged smoothly.72 patients were followed up from 4 to 33 months.The mid-term follow-up showed 13 cases of mild mitral regurgitation,4 cases of mild to moderate reflux,and 3 cases of residual vertebral VSD of 1 to 2 mm.Conclusion Patients with complete atrioventricular septal defect emerge early,and should be diagnosed and treated early.Individualized surgical plan is able to improve the surgical results.The key to successful surgery is to properly repair the atrioventricular valve,pay attention to intraoperative atrioventricular block and postoperative pulmonary hypertension crisis.

关 键 词：完全型房室间隔缺损 房间隔缺损 室间隔缺损 外科手术 

分 类 号：R654.2[医药卫生—外科学]