不同微创封堵方式治疗婴幼儿房间隔缺损的对比研究  

A comparative study of different minimally invasive occlusion in the treatment of atrial septal defects in infants

作　　者：比拉力·排祖拉 迪娜·努尔兰 杨龙[1] 王月茹 伊木然·卡吾力江 陈基尧 马松峰[1] 张国明[1] Bilali PAIZULA;Dina NUERLAN;YANG Long;WANG Yue-ru;Yimuran KAWULIJIANG;CHEN Ji-yao;MA Song-feng;ZHANG Guo-ming(Department of Pediatric Cardiothoracic Surgery,The First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China)

机构地区：[1]新疆医科大学第一附属医院小儿心胸外科,新疆维吾尔自治区乌鲁木齐市830054

出　　处：《中国心血管病研究》2025年第4期342-347,共6页Chinese Journal of Cardiovascular Research

基　　金：新疆维吾尔自治区天山英才培养计划(TSYC202301B036);新疆维吾尔自治区研究生创新项目(XJ2024G167)。

摘　　要：目的 探讨超声心动图引导下经颈内静脉封堵、经股静脉封堵、右腋下切口经胸封堵婴幼儿房间隔缺损(atrial septal defect,ASD)的疗效及适应证。方法 回顾性分析2022年1月至2023年12月新疆医科大学第一附属医院小儿心胸外科收治的接受微创封堵治疗的131例单纯ASD婴幼儿(0~3岁)临床资料。根据手术方式不同分为颈静脉组(n=39)、股静脉组(n=44)、右腋下组(n=48)。比较三组患儿年龄、体重、ASD直径、手术时间、术中出血量、术后住院时间、住院费用、术后残余分流发生率、术后并发症发生率及术后1 h、12 h、24 h的FLACC疼痛评分。结果 股静脉组年龄和体重高于颈静脉组和右腋下组,差异有统计学意义(P<0.05),右腋下组ASD直径低于颈静脉组和股静脉组[6.5(5.0,9.0)mm比8.0(7.0,10.0)mm比8.0(6.0,11.0)mm],差异有统计学意义(P<0.05)。右腋下组手术时间[100.00(65.00,103.75)min比60.00(45.00,70.00)min比42.50(35.00,60.00)min]、手术出血量[7(5,9)ml比5(3,5)ml比5(3,5)ml]、术后住院时间[8.0(6.0,10.0)d比4.0(3.0,5.0)d比3.5(3.0,5.0)d]、住院费用[39304(37458,44399)元比24172(23585,25891)元比22309(21408,29693)元]均长于或多于颈静脉组和股静脉组,差异有统计学意义(P<0.05)。三组术后残余分流发生率及并发症发生率没有显著差异(P>0.05)。不同时间点右腋下组FLACC评分均高于颈静脉组、股静脉组,差异有统计学意义(P<0.05)。12 h、24 h股静脉组FLACC评分高于颈静脉组,差异有统计学意义(P<0.05)。结论 超声心动图引导下经颈内静脉、经股静脉、右腋下切口经胸封堵治疗婴幼儿ASD疗效相同。经颈内静脉封堵更合适低龄、低体重婴幼儿,术后舒适度更好。右腋下切口经胸封堵手术适应证广泛,但花费高,术后疼痛明显。经股静脉封堵介于两者之间,适合高龄、大体重婴幼儿。Objective To investigate the efficacy and indications of transcatheter closure of atrial septal defect(ASD) in infants via internal jugular vein,femoral vein and right infra-axillary incision respectively under the guidance of echocardiography.Methods The clinical data of 131 infants(0-3 years old) with simple ASD who received transcathter closure treatment in the Pediatric Cardiothoracic Surgery Department of the First Affiliated Hospital of Xinjiang Medical University from January 2022 to December 2023 were analyzed retrospectively.According to different surgical methods,the patients were divided into the internal jugular vein group(n=39),the femoral vein group(n=44),and the right infra-axillary incision group(n=48).The ages,weights,ASD diameters,operation times,intraoperative blood loss volumes,postoperative hospitalization times,hospitalization costs,incidence of postoperative residual shunt and incidence of postoperative complications as well as postoperative FLACC pain scores at 1 h,12 h and 24 h were compared among the three groups.Results The age and weight of the femoral vein group were older and heavier than the internal jugular vein group and the right infra-axillary incision group(P<0.05),the diameter of the ASD in the right infra-axillary incision group was smaller than the internal jugularvein group and the femoral vein group [6.5(5.0,9.0) mm vs.8.0(7.0,10.0) mm vs.8.0(6.0,11.0) mm](P<0.05).Surgical time [100.00(65.00,103.75) vs.60.00(45.00,70.00) vs.42.50(35.00,60.00) min],intraoperative blood loss volume [7(5,9) vs.5(3,5) vs.5(3,5)ml],postoperative hospitalization time [8.0(6.0,10.0) days vs.4.0(3.0,5.0) days vs.3.5(3.0,5.0) days] and hospitalization cost [39304(37458,44399) yuan vs.24172(23585,25891)yuan vs.22309(21408,29693) yuan] in the right infra-axillary incision group were longer and more than the internal jugular vein group and the femoral vein group(P<0.05).There was no significant difference in the incidence of postoperative residual shunt or complications between the three groups(P>0.05

关 键 词：房间隔缺损 微创治疗 封堵器 疼痛评分 婴幼儿 

分 类 号：R654.7[医药卫生—外科学]