经食管超声心动图引导下经皮卵圆孔未闭封堵术治疗偏头痛安全性和有效性研究  

A study on the safety and efficacy of transesophageal echocardiography-guided percutaneous patent foramen ovale closure for the treatment of migraine

作　　者：周丽君 王健 陈蓓 代娟 叶红梅[1] Zhou Lijun;Wang Jian;Chen Bei;Dai Juan;Ye Hongmei(Department of Ultrasound,The Third Hospital of Mianyang,Mianyang 621000,China)

机构地区：[1]绵阳市第三人民医院超声科,绵阳621000

出　　处：《中国医学装备》2025年第4期64-68,共5页China Medical Equipment

基　　金：四川省科技计划项目任务合同书(2019JDRC0123)。

摘　　要：目的:探讨在经食道超声心动图(TEE)引导下,行经皮卵圆孔未闭(PFO)封堵术治疗偏头痛的安全性及有效性。方法:选择2021年3月至2023年8月期间在绵阳市第三人民医院实施TEE引导下经皮PFO封堵术的偏头痛患者78例。使用头痛影响测定(HIT-6)评分评估患者头痛对日常生活的影响程度。术前常规行TEE、右心声学造影及经颅多普勒超声发泡试验(c-TCD)评估卵圆孔及右向左分流情况。术中在TEE监测下完成PFO封堵,术后即刻行TEE检查,评价封堵效果,并于术后1、3和6个月采用经胸超声心动图(TTE)、右心声学造影及c-TCD随访封堵器形态、位置以及有无残余分流,使用HIT-6评分评估患者头痛是否改善。结果:75例成功在TEE引导下完成经皮PFO封堵术,3例封堵失败,成功率为96%。所有患者均无严重手术并发症。随访过程中,TTE均提示封堵器位置、形态良好,未出现心包积液。右心声学造影及c-TCD结果显示封堵后右向左分流量(RLS)明显减少甚至消失。HIT-6评分显示封堵术后1、3和6个月评分<50分患者例数均增多,分别为44、49和64例,差异均有统计学意义(x^(2)=49.912、82.041、96.189,P<0.05)。结论:单纯TEE引导下经皮PFO封堵术安全,对偏头痛的近期效果良好。Objective:To explore the safety and efficacy of transesophageal echocardiography(TEE)-guided percutaneous patent foramen ovale(PFO)closure in treating migraine.Methods:A total of 78 patients with migraine who underwent TEE-guided percutaneous PFO closure at The Third Hospital of Mianyang between March 2021 and August 2023 were included in the study.The impact of headache on daily life was assessed using the Headache Impact Test(HIT-6)score.Preoperatively conventional examination included TEE,right heart acoustic imaging,and contrast transcranial Doppler(c-TCD)were conducted to assess the situation of foramen ovale and right-to-left shunt(RLS).PFO closure was completed under TEE monitoring in surgery,and TEE examination was immediately implemented after surgery so as to evaluate the effect of closure.The transthoracic TTE,right heart acoustic imaging and c-TCD were adopted to conduct follow-up for the form and position of occluder,and the situation of residual shunt at the 1st,3rd and 6th month after surgery.HIT-6 score was used to assess whether the headache of patients was improved.Results:Transesophageal echocardiography(TEE)-guided PFO closure was successfully performed in 75 patients(success rate was 96%),while 3 cases was failure in closure.There was not major surgical complications in all patients.During follow-up,TTE demonstrated the position and form of occluder were well,and there was not pericardial effusion.The results of right heart acoustic imaging and c-TCD showed the RLS obviously reduced or even disappeared after closure.HIT-6 scores showed the number of patients,whose scores were less than 50 scores,increased at the 1st,3rd and 6th after closure,which were respectively 44 cases,49 cases and 64 cases,and the differences of them were significant(x^(2)=49.912,82.041,96.189,P<0.05).Conclusion:The single TEEguided percutaneous PFO closure is safe,which short-term outcomes is favorable for migraine.This technique is worth in clinical application.

关 键 词：卵圆孔未闭 食道超声 介入 封堵术 

分 类 号：R445.1[医药卫生—影像医学与核医学]