缺损上缘距主动脉瓣≤2 mm室间隔缺损经胸封堵治疗有效性观察  

Observation of the effectiveness of transthoracic closure therapy for ventricular septal defects with a distance from the superior margin of the defect to the aortic valve≤2 mm

作　　者：刘桂栋 张峰 黄晓碧 朱文庆 LIU Gui-dong;ZHANG Feng;HUANG Xiao-bi;ZHU Wen-qing(Department of Pediatric Cardiovascular Surgery,Anhui Provincial Children’s Hospital,Hefei 230022,China;Department of Pediatric Cardiovascular,Anhui Provincial Children’s Hospital,Hefei 230022,China)

机构地区：[1]安徽省儿童医院儿童心血管外科,安徽省合肥市230022 [2]安徽省儿童医院儿童心血管科,安徽省合肥市230022

出　　处：《中国心血管病研究》2024年第10期929-933,共5页Chinese Journal of Cardiovascular Research

摘　　要：目的观察超声引导下经胸微创封堵治疗小儿缺损上缘距主动脉瓣≤2 mm膜周部室间隔缺损的有效性。方法回顾性分析2017年3月-2023年8月安徽省儿童医院收治的110例缺损上缘距主动脉瓣≤2 mm膜周部室间隔缺损的患儿,根据手术方式分为外科组(n=61)和封堵组(n=49)。外科组施行传统体外循环下修补手术治疗,封堵组给予超声引导下经胸微创封堵治疗。记录两组的手术时间、呼吸机辅助时间、重症监护治疗时间、手术总出血量、术后住院时间、围术期并发症及术后6个月超声心动图参数。结果封堵组患儿的手术时间、呼吸机辅助时间、术后住院天数均短于外科组[61.8(49.8,77.4)min比140.0(130.0,160.0)min、100.0(67.5,120.0)min比210.0(175.0,240.0)min、4.0(3.0,5.0)d比6.0(6.0,6.0)d,均P<0.05];封堵组手术中位总出血量少于外科组[0.0(0.0,62.5)ml比115.0(90.0,140.0)ml,P<0.05];术后两组并发症发生率无显著差异(P>0.05);术后6个月与治疗前相比,两组患儿左心室舒张末径均下降(P<0.05),两组心律失常发生率,封堵组0%,外科组6.6%,无显著差异(P>0.05),封堵组新发瓣膜反流发生率大于外科组(8.2%比0%,P<0.05)。结论超声引导经胸封堵治疗缺损上缘距主动脉瓣≤2 mm膜周部室间隔缺损的患儿,对于不合并主动脉瓣反流的病例,疗效满意,是一种安全、可行的术式。Objective To observe the effectiveness of ultrasound-guided thoracoscopic minimally invasive occlusion therapy for the treatment of perimembranous ventricular septal defects with the upper margin of the defect≤2 mm from the aortic valve in children.Methods A retrospective analysis was conducted on 110 children with perimembranous ventricular septal defects with the upper margin of the defect≤2 mm from the aortic valve admitted to Anhui Provincial Children's Hospital from March 2017 to August 2023.The patients were divided into a surgical group(n=61)and an occlusion group(n=49)based on the surgical approach.The surgical group underwent traditional repair surgery under extracorporeal circulation,while the occlusion group received ultrasound-guided thoracoscopic minimally invasive occlusion therapy.The operation time,ventilator assistance time,intensive care unit stay time,total intraoperative blood loss,postoperative hospital stay,perioperative complications,and echocardiographic parameters at 6 months postoperatively were recorded for both groups.Results The operation time,mechanical ventilation time and the postoperative hospital stay in the occlusion group were significantly shorter than the surgery group[61.8(49.8,77.4)min vs.140.0(130.0,160.0)min、100.0(67.5,120.0)min vs.210.0(175.0,240.0)min、4.0(3.0,5.0)d vs.6.0(6.0,6.0)d,all P<0.05].The median total blood loss was less in the occlusion group than in the surgery group[0.0(0.0,62.5)ml vs.115.0(90.0,140.0)ml,P<0.05].The incidence of postoperative complications has no significant difference between the two groups(P>0.05).There was no significant difference in the incidence of arrhythmia between the two groups(P>0.05).The incidence of new valvular regurgitation in the occlusion group was higher than that in the surgery group(8.2%vs.0%,P<0.05).Conclusion Ultrasound-guided transthoracic occlusion for children with perimembranous ventricular septal defects with the upper edge of the defect≤2 mm from the aortic valve.For cases without combined aortic valve r

关 键 词：室间隔缺损 主动脉瓣脱垂 经胸微创封堵 超声心动图 体外循环 

分 类 号：R654.2[医药卫生—外科学]