经右心室穿刺室间隔缺损封堵142例疗效分析
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摘要
目的分析总结经胸小切口右心室穿刺室间隔缺损(VSD)封堵术的临床疗效。方法回顾分析广东省中医院大学城医院2013年7月至2017年9月经胸小切口右心室穿刺封堵术治疗VSD病人142例。术中行经食管超声心动图评估VSD是否适合封堵治疗,确定封堵器型号,超声定位经右心室穿刺置入封堵器,评判封堵效果,出院后对病人进行随访。结果 142例VSD病人均成功封堵,成功率100%。1例术后3 d发现封堵器移位导致残余分流二次手术行体外循环下VSD修补术。1例术后5 d发现残余分流较大二次手术行体外循环下VSD修补术。142例病人均顺利出院。随访1～51个月,138例无残余分流,余4例有2 mm残余分流,142例心电图均无房室传导阻滞,心功能均良好。结论超声心动图引导下经胸小切口右心室穿刺VSD封堵术不需要体外循环辅助,手术创伤小,安全性高,近期疗效好,远期疗效待进一步观察。
Objective To evaluate the feasibility of minimally invasive transthoracic ventricular septal defect occlusion application.Methods From July 2013 to September 2017 in Guangdong Provincail Hospital of Chinese Medcine,142 patients with ventricular septal defect were enrolled in this study.Transesophageal echocardiography were performed to choose an appropriate occluder device according to location,type and size of the ventricular septal defect,and to guide the occuluder device,analyse the clinical effect after the surgery.Results All the 142 patients with VSD were successfully occluded.The success rate was 100%,but 2 patients underwent reoperation because of residual shunt.A follow-up between 1 to 51 months show that there was no residual shunt in 138 patients,and no atrioventricular block in all patients.Conclusion Minimally invasive transthoracic ventricular device closure of ventricular septal defect is safe and feasible.
Objective To evaluate the feasibility of minimally invasive transthoracic ventricular septal defect occlusion application.Methods From July 2013 to September 2017 in Guangdong Provincail Hospital of Chinese Medcine,142 patients with ventricular septal defect were enrolled in this study.Transesophageal echocardiography were performed to choose an appropriate occluder device according to location,type and size of the ventricular septal defect,and to guide the occuluder device,analyse the clinical effect after the surgery.Results All the 142 patients with VSD were successfully occluded.The success rate was 100%,but 2 patients underwent reoperation because of residual shunt.A follow-up between 1 to 51 months show that there was no residual shunt in 138 patients,and no atrioventricular block in all patients.Conclusion Minimally invasive transthoracic ventricular device closure of ventricular septal defect is safe and feasible.
引文
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[5]李小波,万亚红,邬云龙,等.低龄低体重患儿经胸小切口封堵膜周部室间隔缺损的策略及早期疗效[J].中国微创外科杂志,2012,12(11):964-965,968.
[6]朱鲜阳,秦永文,张玉顺,等.常见先天性心脏病介入治疗中国专家共识//中国医师协会心血管内科医师分会,中国老年学学会心脑血管病专业委员会,中国医师协会循证医学专业委员会.心血管疾病防治指南和共识2009[M].北京:人民卫生出版社,2009:1-103.
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[9]WALSH MA,BIALKOWSKI J,SZKUTNIK M,et al.Atrioventricular block after transcatheter closure of perimembranous ventricular septal defects[J].Heart,2006,92(9):1295-1297.
[10]徐帆,陈道中,陈良万,等.微创经胸室间隔缺损封堵术在婴幼儿中的应用[J].中国心血管病研究,2012,10(1):12-15.
[11]吴勤,高雷,徐新华,等.偏心型封堵器在外科微创封堵治疗室间隔缺损中的应用[J].中南大学学报(医学版),2013,38(5):490-498.
[12]周子娟,刘迎春,马林,等.经胸小切口食管超声心动图引导下室间隔缺损外科封堵术及围手术期护理[J].安徽医药,2017,21(5):960-963.
[2]张亚飞,王克学,王岩青,等.经胸微创室间隔缺损封堵术50例疗效分析[J].心肺血管病杂志,2014,33(3):395-397,401.
[3]张玉展,李红昕,黄犇,等.经胸微创室间隔缺损封堵术的临床研究[J].河北医药,2012,34(18):2746-2747.
[4]邢泉生,泮思林,武钦,等.经胸微创非体外循环下封堵室间隔缺损:多中心经验和近中期随访结果[J].中华胸心血管外科杂志,2011,27(5):259-263.
[5]李小波,万亚红,邬云龙,等.低龄低体重患儿经胸小切口封堵膜周部室间隔缺损的策略及早期疗效[J].中国微创外科杂志,2012,12(11):964-965,968.
[6]朱鲜阳,秦永文,张玉顺,等.常见先天性心脏病介入治疗中国专家共识//中国医师协会心血管内科医师分会,中国老年学学会心脑血管病专业委员会,中国医师协会循证医学专业委员会.心血管疾病防治指南和共识2009[M].北京:人民卫生出版社,2009:1-103.
[7]尚小珂,张刚成,沈群山,等.距离主动脉瓣右冠状动脉瓣不足2mm的膜周型室间隔缺损介入封堵效果分析[J].中国介入心脏病学杂志,2014,22(2):92-97.
[8]BUTERA G,CARMINATI M,CHESSA M,et al.Percutaneous closure of ventricular septal defects in children aged<12:early and mid-term results[J].Eur Heart J,2006,27(23):2889-2895.
[9]WALSH MA,BIALKOWSKI J,SZKUTNIK M,et al.Atrioventricular block after transcatheter closure of perimembranous ventricular septal defects[J].Heart,2006,92(9):1295-1297.
[10]徐帆,陈道中,陈良万,等.微创经胸室间隔缺损封堵术在婴幼儿中的应用[J].中国心血管病研究,2012,10(1):12-15.
[11]吴勤,高雷,徐新华,等.偏心型封堵器在外科微创封堵治疗室间隔缺损中的应用[J].中南大学学报(医学版),2013,38(5):490-498.
[12]周子娟,刘迎春,马林,等.经胸小切口食管超声心动图引导下室间隔缺损外科封堵术及围手术期护理[J].安徽医药,2017,21(5):960-963.