食管超声引导经胸微创封堵治疗婴幼儿室间隔缺损并主动脉瓣脱垂的效果  

Analysis of effect of minimally invasive transthoracic closure of ventricular septal defect with aortic valve prolapse guided by transesophageal echocardiography

作　　者：于文波[1] 陈振良[1] 董向阳[1] 陈忠建 崔亚洲 王鹏高 翟波 Yu Wenbo;Chen Zhenliang;Dong Xiangyang;Chen Zhongjian;Cui yazhou;Wang Penggao;Zhai Bo(Department of cardiothoracic surgery,Children's Hospital affiliated to Zhengzhou University,Henan children's Hospital,Zhengzhou children's Hospital,Zhengzhou 450000,China)

机构地区：[1]郑州大学附属儿童医院(河南省儿童医院郑州儿童医院)胸心外科,郑州450000

出　　处：《河南外科学杂志》2021年第6期5-8,共4页Henan Journal of Surgery

基　　金：河南省医学科技攻关联合共建项目(LHGJ20190889)。

摘　　要：目的探讨食管超声(TEE)引导经胸微创封堵治疗婴幼儿室间隔缺损(VSD)并主动脉瓣脱垂(AVP)的效果。方法回顾性分析2015-08—2019-07郑州大学附属儿童医院行TEE引导经胸微创封堵治疗的62例VSD并AVP患儿的临床资料。记录手术年龄、体质量、缺损位置、手术时间、AVP程度、手术前后主动脉瓣反流和封堵器使用情况、术后残余分流和心律失常等并发症,以及随访结果。结果62例患儿的年龄(12.8±9.5)个月,体质量(10.5±6.4)kg。膜周型23例,嵴上型39例。轻度AVP 41例,中度AVP 21例。术前主动脉瓣轻度反流8例、膜周型3例、嵴上型5例,差异无统计学意义(P=0.995)。轻度AVP 1例,中度AVP 7例,差异有统计学意义(P=0.002)。均在TEE引导下经胸骨下段小切口(1.5~2.5 cm)顺利完成微创封堵术,无1例中转体外循环手术,手术时间(58.5±23.6)min。主动脉瓣轻度反流8例中,3例术后即转为轻微,其余5例经随访发现反流均减轻甚至消失。嵴上型VSD偏心封堵器使用36例,膜周型13例,中度AVP偏心封堵器使用21例,轻度AVP 28例,差异均有统计学意义(P<0.05)。1例术后第5天复查心脏彩超发现偏心封堵器偏移,再次开胸行封堵器取出并VSD修补术,住院(6.5±3.2)d出院,术后门诊复查均未出现封堵器脱落移位、残余分流或梗阻、传导阻滞和瓣膜反流等并发症。结论在TEE引导下,合理的封堵器选择及微创操作策略,经胸骨下段小切口路径能安全有效实施VSD并AVP患儿的微创封堵术,近中期效果良好。Objective To investigate the effect of minimally invasive thoracic closure guided by transesophageal echocardiography(TEE)in the treatment of infant ventricular septal defect(VSD)with aortic valve prolapse(AVP).Methods Retrospective analysis was performed on the clinical data of 62 children with VSD and AVP who received TEE guided minimally invasive thoracic closure in Children's Hospital Affiliated to Zhengzhou University from August 2015 to July 2019.Surgical age,body weight,defect location,operative time,AVP degree,preoperative and postoperative aortic regurgitation and use of occluder,postoperative residual shunt,arrhythmia and other complications,as well as follow-up results were recorded.Results The age of 62 children were(12.8±9.5)months,and their body weight was(10.5±6.4)kg.There were 23 cases of perimembrane type and 39 cases of supraspinal type.There were 41 cases of mild AVP and 21 cases of moderate AVP.There were 8 cases of mild aortic valve regurgitation,3 cases of perimembrane type and 5 cases of supraspinal type before operation,and the difference was not statistically significant(P=0.995).Mild AVP in 1 case,moderate AVP in 7 cases,the difference was statistically significant(P=0.002).All patients successfully completed minimally invasive occlusion through small incision(1.5~2.5 cm)in the lower sternum under the guidance of TEE,and no patient was transferred to extracorporeal circulation with an average operation time of(58.5±23.6)min.Of the 8 cases of mild aortic valve regurgitation,3 cases became mild immediately after operation,and the other 5 cases were found to be relieved or even disappeared by follow-up.There were 36 cases of supra-crest VSD eccentric umbrella,13 cases of perimembrane type,21 cases of moderate AVP eccentric umbrella,and 28 cases of mild AVP eccentric umbrella,the differences were statistically significant(P<0.05).On the 5th day after surgery,color doppler echocardiography was performed on 1 patient,and the eccentric occluder was removed and VSD repair was performed again.

关 键 词：微创封堵 食道管 超声 婴儿室间隔缺损 主动脉瓣脱垂 

分 类 号：R654.2[医药卫生—外科学]