CAJ | 학술논문

目的分析残余室间隔缺损(VSD)的发生原因、防治措施、手术指征和手术要点。方法对12例施行残余VSD再手术治疗患者的发生原因、预防措施、手术指征和手术要点进行分析。结果 12例中8例首次手术于1977年至1997年在我院施行，4例在外院施行，我院VSD再手术率为0.18％。首次手术时单纯VSD 9例，法洛四联症(TOF)3例。两次手术间期平均4.1年(5个月～12年)。再次手术发现10例VSD再通部位均在三尖瓣前隔瓣基底附近，残余VSD长径平均1.2 cm(0.3～2.5 cm)。手术死亡3例，死亡原因包括低心排、心律失常和心包填塞。结论 1.VSD再通好发于三尖瓣前隔瓣基底邻近，这与该区域邻近主动脉瓣和传导束等重要而结构复杂、可利用缝合的坚固组织少、三尖瓣叶和腱索的遮挡造成VSD的边缘暴露不清等因素有关。2.预防VSD再通关键在于充分暴露VSD边缘，防止漏缝和撕裂。3.0.5 cm以上的残余VSD应尽早手术。4．再次手术以右房切口和补片修补为佳，术终止血要严密。
목적분석잔여실간격결손(VSD)적발생원인、방치조시、수술지정화수술요점。방법대12례시행잔여VSD재수술치료환자적발생원인、예방조시、수술지정화수술요점진행분석。결과 12례중8례수차수술우1977년지1997년재아원시행，4례재외원시행，아원VSD재수술솔위0.18％。수차수술시단순VSD 9례，법락사련증(TOF)3례。량차수술간기평균4.1년(5개월～12년)。재차수술발현10례VSD재통부위균재삼첨판전격판기저부근，잔여VSD장경평균1.2 cm(0.3～2.5 cm)。수술사망3례，사망원인포괄저심배、심률실상화심포전새。결론 1.VSD재통호발우삼첨판전격판기저린근，저여해구역린근주동맥판화전도속등중요이결구복잡、가이용봉합적견고조직소、삼첨판협화건색적차당조성VSD적변연폭로불청등인소유관。2.예방VSD재통관건재우충분폭로VSD변연，방지루봉화시렬。3.0.5 cm이상적잔여VSD응진조수술。4．재차수술이우방절구화보편수보위가，술종지혈요엄밀。
Objective To analyze the causation, surgical indications and pivotal points in reoperation of residual ventricular septal defect (VSD). Methods Collecting the clinical data of 12 cases of reoperated residual VSD in this hospital from 1988 to 1998 and investigating into insight of their causation, surgical indications and keys elements of reoperation in residual VSD. Results This group consisted of 12 patients of whom 8 were operated in this hospital from 1977 to 1997, and 4 were operated in other hospital. The re-operative rate of VSD in our hospital was 0.18 %.The defects in the first operation were 8 cases of simple VSD and 3 tetralogy of Fallot. The mean interval between the two operations was 4.1 years (5 months-12 years). Residual shunting in 10 patients were adjacent to the base of anterior and septal leaflets of tricuspid valve. The mean longitudinal diameter of residual VSD was 1.2 cm(0.3～2.5 cm).Three patients died after reoperation. Causes of death included low cardiac output syndrome, cardiac arrhythmia and cardiac tamponade. Conclusion 1. The common location of residual VSD is around the base of anterior and septal leaflets of tricuspid valve, this area involves some important structures like aortic valve and AV bundle which are not easily exposed. 2. Adequate exposure of entire VSD margin is the key element to avoid leakage by laceration. 3. Early re-operation is required for all residual VSD with diameter above 0.5 cm. 4. The key points of reoperation are timely operation, atrial incisional approach, patch repairment and careful hemostasis.