经皮与经胸介入封堵治疗婴儿大型动脉导管未闭  

Clinical efficacy of percutaneous and transthoracic interventional occlusion in the treatment of large patent ductus arteriosus in infants

作　　者：孔中政 高植 孙士彬 李红昕 KONG Zhongzheng;GAO Zhi;SUN Shibin;LI Hongxin(Clinical Medical College,Shandong Second Medical University,Weifang 261053,Shandong,China;Department of Cardiovascular Surgery,The First Affiliated Hospital of Shandong First Medical University&Shandong Provincial Qianfoshan Hospital/Shandong Engineering Research Center for Heart Transplant and Material,Jinan 250014,Shandong,China)

机构地区：[1]山东第二医科大学临床医学院,山东潍坊261053 [2]山东第一医科大学第一附属医院(山东省千佛山医院)心血管外科学/山东省心脏移植与材料工程技术研究中心,山东济南250014

出　　处：《山东大学学报（医学版）》2024年第11期32-39,共8页Journal of Shandong University:Health Sciences

基　　金：山东省研究型医院协会科研项目(2022017)。

摘　　要：目的 鉴于婴儿大型动脉导管未闭(patent ductus arteriosus, PDA)的介入治疗充满挑战性,主要原因是婴儿外周血管细,组织稚嫩,而所需封堵器大、输送鞘粗,造成经皮封堵的难度和风险增大。本文旨在探讨经胸与经皮介入封堵婴儿大型PDA的临床疗效。方法 回顾性分析145例婴儿期大型PDA患者(PDA直径≥4 mm)临床资料,收集患者的PDA直径、左室舒张末期内径、手术相关数据等指标,根据介入途径的不同,将患儿分为DSA引导下经皮组(95例)和食管超声引导下经胸组(50例)。观察两组患儿的手术疗效。结果 两组患儿均取得良好的手术成功率,7~12月龄的两组患儿中,经胸组肺动脉侧缺损平均直径(5.80±1.29)mm(范围4.00~10.00 mm);主动脉侧缺损平均直径(8.14±2.16)mm(范围5.20~15.00 mm),封堵器大小为(8.12±1.65)mm(范围6.00~12.00 mm);经皮组肺动脉侧缺损平均直径(5.14±0.94)mm(范围4.00~9.50 mm);主动脉侧缺损平均直径(6.66±1.25)mm(范围4.00~12.70 mm),封堵器大小为(7.83±1.93)mm(范围6.00~10.00 mm)。以上数据以及两组患者的术后的肺动脉收缩压(pulmonary artery systolic pressure, PASP)均较术前有不同程度的下降(P<0.05)。0~6月龄的两组患儿中,经胸组肺动脉侧缺损平均直径(5.14±1.51)mm(范围4.00~10.00 mm)、主动脉侧缺损平均直径(6.68±1.80)mm(范围4.00~10.00 mm);经皮组肺动脉侧缺损平均直径(5.11±1.24)mm(范围4.00~8.40 mm),主动脉侧缺损平均直径(5.92±0.63)mm(范围5.00~7.00 mm);两组的封堵器大小分别为(7.63±1.67)mm(范围6.00~12.00 mm)和(6.83±1.34)mm(范围6.00~10.00 mm),数据差异无统计学意义。随访结果显示,并未有封堵器脱落、心律失常及残余分流等并发症发生。结论 经胸及经皮微创封堵婴儿期大型PDA均是安全有效的治疗方式,对于体质量低、低月龄患儿,若外周血管纤细、穿刺及置管困难的,可采用经胸微创封堵的手术路径。Objective To evaluate the clinical efficacy of minimally invasive perpulmonary and percutaneous closure of the patent ductus arteriosus(PDA)in infants.Methods A retrospective analysis was performed on 145 infants diagnosed with a large PDA≥4.0 mm in diameter.Data on PDA size,left ventricular end-diastolic diameter and operation-related parameters were collected for each patient.Based on the different interventional approaches,the infants were divided into two groups:the DSA-guided percutaneous closure group(n=95)and the Echo-guided perpulmonary closure group(n=50).The clinical efficacy of both groups was evaluated.Results Both groups achieved a high success rate of 100%in the Echo-guided perpulmonary closure group and 100%in the percutaneous approach.In the DSA-guided perpulmonary closure group for the patients aged from 7 to 12 months,the mean minimum diameter of PDA at the pulmonary end was(5.80±1.29)mm(range,4.00-10.00 mm),the mean maximum diameter of PDA at the aortic end was(8.14±2.16)mm(range,5.20-15.00 mm),and the size of the implanted device was(8.12±1.65)mm(range,6.00-12.00 mm).Similarly,in the DSA-guided percutaneous closure group,the mean minimum and maximum diameters of PDA were(5.14±0.94)mm(range,4.00-9.50 mm)and(6.66±1.25)mm(range,4.00-12.70 mm),respectively.The implanted device size was(7.83±1.93)mm(range,6.00-10.00 mm).The above data and the postoperative pulmonary artery systolic pressure(PASP)of both groups were lower than before surgery(P<0.05).In the Echo-guided perpulmonary closure group for the patients aged from 0 to 6 months,the mean minimum diameter of PDA at the pulmonary end was(5.14±1.51)mm(range,4.00-10.00 mm),and the mean maximum diameter of PDA at the aortic end was(6.68±1.80)mm(range,4.00-10.00 mm).Similarly,in the DSA-guided percutaneous closure group,the mean minimum and maximum diameters of PDA were(5.11±1.24)mm(range,4.00-8.40 mm)and(5.92±0.63)mm(range,5.00-7.00 mm),respectively.The implant device size was(7.63±1.67)mm(range,6.00-12.00 mm)and(6.83±1.34)mm(range,6.

关 键 词：动脉导管未闭 经胸 经皮封堵 先天性心脏病 

分 类 号：R654.2[医药卫生—外科学]