食管超声心动图引导下婴儿膜周部室间隔缺损经胸微创封堵治疗及中长期随访  

The efficacy and its mid-to long-term follow-up of transthoracic minimally invasive device closure of perimembranous ventricular septal defects under transesophageal echocardiography guidance in infants

作　　者：吴丽映 陈海生 叶东挺 张雄 李彬[2] 邹增晓 朱大量 WU Li-ying;CHEN Hai-sheng;YE Dong-ting;ZHANG Xiong;LI Bin;ZOU Zeng-xiao;ZHU Da-liang(Seven Department of Surgery,Guangdong Armed Police Corps Hospital,Guangzhou 510507,China;Department of Cardiovascular Surgery,Guangzhou First People's Hospital,School of Medicine,South China university of Technology,Guangzhou 510180,China)

机构地区：[1]中国人民武装警察部队广东省总队医院外七科,广东省广州市510507 [2]广州市第一人民医院心脏大血管外科,广东省广州市510507

出　　处：《中国心血管病研究》2020年第5期475-478,共4页Chinese Journal of Cardiovascular Research

基　　金：广东省医学科学技术研究基金项目(A2017523)。

摘　　要：目的评价食管超声心动图引导下经胸微创封堵术在婴儿膜周部室间隔缺损(VSD)治疗效果及中长期随访结果.方法回顾性分析2014年8月至2019年10月期间,我科1岁以下26例先天性心脏病膜周部VSD婴儿行食管超声心动图引导下小切口VSD经胸封堵手术的临床资料.结果26例患儿中,25例封堵成功,1例术中置入封堵器后出现主动脉瓣轻度反流而转外科修补手术,封堵成功率为96.15%,全组患者手术顺利,术后痊愈出院,无死亡,与同期行体外循环下直视VSD修补手术的1岁以下39例患儿对比,手术时间[(81.50±13.53)min比(129.62±29.23)min]、术后呼吸机辅助时间[(294.55±102.94)min比(655.41±370.37)min]、术后引流量[(59.12±20.10)ml比(93.54±27.22)ml]、术后住院时间[(9.68±2.81)d比(11.03±1.99)d]差异具有统计学意义(P<0.05),经胸封堵组无输血,差异具有统计学意义(P<0.05).随访2~66个月,平均随访(34.76±24.55)个月,生长发育良好,如健康同龄儿童.2例术后早期出现不完全性右束支传导阻滞在半年随访已恢复,无新发主动脉瓣或三尖瓣反流,无房室传导阻滞等并发症发生.结论食管超声心动图引导下经胸微创封堵术治疗婴儿膜周部VSD,与同期常规体外循环心内直视VSD修补术比较,创伤小、出血少、恢复快、术后中长期随访效果好,是可行的、安全有效的微创治疗方法.Objective To evaluate the efficiency and safety of transthoracic minimally invasive device closure(TMIDC)of perimembranous ventricular septal defect(pmVSD)in infants under transesophageal echocardiography guidance(TEE)and its mid-to long-term follow-up results.Methods The clinical data of patients under the age of 1 year underwent TMIDC of pmVSD between August 2014 to October 2019 were retrospectively analyzed.Results Among 26 children,in all cases TEE was used for guidance,procedural success was 25/26(96%).The unsuccessful procedure was occurred due to the aortic valve regurgitation after device deployment.This patient underwent surgical removal of the device and patch closure of VSD during the same operation.Moreover,the TMIDC showed the advantages over 39 patients infants underwent the open heart septal defect repair with cardiopulmonary bypass and significant differences(P<0.05)exist in terms of operation time[(81.50±13.53)min vs.(129.62±29.23)min],postoperative mechanical ventilation time](294.55±102.94)min vs.(655.41±370.37)min],operation drainage[(59.12±20.10)ml vs.(93.54±27.22)ml],follow-up period of hospitalization[(9.68±2.81)d vs.(11.03±1.99)d]and the rate of transfusion,all patients were doing well clinically in mean(34.76±24.55)months(2-66 months)follow-up.During follow-up there were no major complication(valvular regurgitation,severe conduction abnormalities or death).Two patients developed incomplete right bundle branch block after surgery and were recovered after 6 months.Conclusion TMIDC under TEE guidance gives good mid-to long-term follow-up results,compared with the infants underwent the open heart septal defect repair with cardiopulmonary bypass,which is seems to be an effective and safe treatment option for selected infants with pmVSD.

关 键 词：微创外科 封堵 室间隔缺损 婴幼儿 随访 

分 类 号：R654.2[医药卫生—外科学]