经胸小切口环缩后封堵粗大窗型/管型动脉导管未闭的疗效及安全性评估  

Occlusion of large window/tubular-type patent ductus arteriosus after constriction via a small chest incision

作　　者：赵烨 陈洪余 石美容 李琪 张慧 郑丽英 王泽陆 苏蕾 文平 ZHAO Ye;CHEN Hongyu;SHI Meirong;LI Qi;ZHANG Hui;ZHENG Liying;WANG Zelu;SU Lei;WEN Ping(Department of Ultrasound,Dalian Municipal Women and Children's Medical Center(Group),Dalian 116012,China;Department of Cardiothoracic Surgery,Dalian Municipal Women and Children's Medical Center(Group),Dalian 116012,China)

机构地区：[1]大连市妇女儿童医疗中心(集团)超声科,辽宁大连116012 [2]大连市妇女儿童医疗中心(集团)心外科,辽宁大连116012

出　　处：《大连医科大学学报》2024年第4期335-338,345,共5页Journal of Dalian Medical University

摘　　要：目的观察经食管超声(TEE)引导下经胸小切口先外科环缩部分动脉导管未闭(PDA)管腔,再穿刺主肺动脉前壁置入封堵器完全封堵剩余管腔治疗粗大窗型/管型PDA患儿的效果并评估其安全性。方法对2017年9月至2022年9月期间收治的14例粗大窗型/管型PDA患儿进行回顾性研究。手术方法为TEE引导下经胸小切口先外科环缩部分管腔,然后在主肺动脉前壁合适位置穿刺,置入合适的室间隔封堵器完全封堵剩余PDA管腔。记录手术时间、手术失血量、术后住院时间及术后并发症发生情况,出院后定期门诊随访。结果14例患儿PDA治疗均获得成功,无一例改为体外循环下补片修补术或PDA结扎术。平均手术时间为(54.3±13.7)min,术后超快通道拔除气管插管后送回普通病房。所有患儿均不需要输血。术后平均住院时间(4.7±1.5)d。所有患儿无封堵器移位、残余分流、溶血或心包积液等并发症发生。平均随访(46.6±10.8)个月,无残余分流、封堵器移位、心包积液发生。结论TEE引导下经胸小切口外科环缩粗大窗型/管型PDA部分管腔,再封堵剩余管腔可获得满意的预后,且可以避免患儿遭受体外循环创伤,避免直接结扎导致PDA破裂大出血的风险。Objective To investigate the therapeutic efficacy and evaluate the safety of a procedure involving partial ring constriction of patent ductus arteriosus(PDA)followed by complete occlusion with an occluder guided by transesophageal echocardiography(TEE),in 14 children with large window/tubular-type PDA.Methods A retrospective study was conducted on14 children with large window/tubular-type PDA,who were admitted from September 2017 to September 2022.The surgical method involved partial ring constriction of the PDA via a small transthoracic incision,followed by puncture at a suitable position on the anterior wall of the main pulmonary artery and placement of a suitable ventricular septal occluder to completely seal the remaining PDA lumen.The operation time,blood loss,postoperative hospital stay,and incidence of postoperative complications were recorded,and the patients were followed-up regularly in outpatient clinics after discharge.Results All 14children successfully underwent PDA treatment,and none of them required conversion to mesh repair or PDA ligation under cardiopulmonary bypass.The average operation time was(54.3±13.7)min,and patients were transferred back to the general ward after extubation through a fast-track protocol.No blood transfusions were needed.The average hospital stay after surgery was(4.7±1.5)days.There were no complications such as occluder displacement,residual shunt,hemolysis,or pericardial effusion.The average follow-up period was(46.6±10.8)months,and there were no residual shunts,occluder displacement,or pericardial effusion.Conclusion TEE-guided transthoracic small incision surgery can achieve satisfactory outcomes through partial ring constriction of large window/tubular-type PDA followed by occlusion of the remaining lumen.This approach can avoid the trauma of cardiopulmonary bypass and reduce the risk of PDA rupture and massive bleeding associated with direct ligation.

关 键 词：儿童 动脉导管未闭 食道超声 微创 

分 类 号：R726.1[医药卫生—儿科]