高位室间隔缺损患儿经胸微创封堵的治疗效果  

Effect of Transthoracic Minimally Invasive Closure for High Ventricular Septal Defect in Children

作　　者：涂洪强[1] 陈苏江[1] 张盛[1] 黄国金[1] TU Hong-qiang;CHEN Su-jiang;ZHANG Sheng;HUANG Guo-jin(Heart Center of Jiangxi Children’s Hospital,Jiangxi Key Laboratory of Cardiovascular Diseases for Healthy Children,Nanchang 330038,China)

机构地区：[1]江西省儿童医院心脏中心,江西省卫生健康儿童心血管疾病重点实验室,南昌330038

出　　处：《实用临床医学（江西）》2023年第1期22-24,62,共4页Practical Clinical Medicine

基　　金：江西省科技厅重点研发计划(20192BBGL70001);江西省卫健委科技计划(20203691)。

摘　　要：目的探讨高位室间隔缺损患儿经胸微创封堵治疗的临床效果。方法回顾性分析2018—2021年经胸微创封堵治疗的206例高位室间隔缺损患儿的临床资料。其中男137例,女69例;年龄(34.49±31.72)个月;体重(13.64±7.22)kg;干下型135例,嵴内型71例。患儿在全身麻醉、气管插管下进行手术,经胸骨下端正中小切口,在经食管超声(TEE)引导下置入封堵器,闭合室间隔缺损。结果206例患儿中,192例(93.2%)封堵成功;14例(6.8%)于术中转行体外循环下直视修补术均成功,其中主动脉瓣反流加重或合并残余分流明显6例(2.9%),封堵器位置不稳定5例(2.4%),右室面隔膜样组织遮挡导致导丝通过困难3例(1.5%)。住院时间(11.57±2.56)d。随访3个月至4年,未见封堵器移位、瓣膜反流、心律失常、残余分流、溶血等并发症发生。结论在TEE引导下经胸微创封堵治疗高位室间隔缺损临床效果确切、安全、可行、创伤小、恢复快。而对于主动脉瓣膜脱垂明显或主动脉瓣骑跨明显的室间隔缺损患儿建议常规行体外循环下修补术。Objective To study the clinical effect of transthoracic minimally invasive closure(TMIC)on high ventricular septal defect(VSD)in children.Methods A retrospective analysis was performed on 206 children treated with TMIC for VSD in Jiangxi Children’s Hospital from January 2018 to December 2021(137 males and 69 females,age(34.49±31.72)months,body weight(13.64±7.22)kg),including 135 cases of subarterial VSD and 71 cases of intracristal VSD.All the children were operated under general anesthesia with endotracheal intubation.The VSD was closed by placing a closure device under the guidance of transesophageal ultrasound through a small substernal incision.Results Among the 206 cases,192(93.2%)successfully achieved closure,and 14(6.8%)were converted to direct vision repair under cardiopulmonary bypass.Of the 14 cases,6(2.4%)were converted to cardiopulmonary bypass due to aggravated aortic valve regurgitation or combined residual shunt,5(2.9%)due to unstable position of the occluder,and 3(1.5%)due to diaphragm-like tissue occlusion-caused difficulty in passing the guidewire.The average length of hospital stay was(11.57±2.56)days.After 3 months to 4 years of follow-up,no occluder displacement,valve regurgitation,arrhythmia,residual shunt,hemolysis and other complications were observed in all the cases.Conclusion TMIC is effective,safe and feasible for high VSD with advantages of small trauma and quick recovery.Conventional repair under cardiopulmonary bypass is recommended for VSD children with obvious aortic valve prolapse or override.

关 键 词：高位室间隔缺损 经胸微创封堵 食管超声 儿童 

分 类 号：R654.2[医药卫生—外科学]