中国综合临床
中國綜閤臨床
중국종합림상
CLINICAL MEDICINE OF CHINA
2010年
7期
707-709
,共3页
先天性心脏病%室间隔缺损%连续缝合%间断缝合
先天性心髒病%室間隔缺損%連續縫閤%間斷縫閤
선천성심장병%실간격결손%련속봉합%간단봉합
Congenital heart disease%Ventricular septal defect%continuous stitching%Interrupted stitching
目的 比较应用连续缝合法与间断缝合法修补膜周型室间隔缺损(VSD)的外科技术并进行疗效评价.方法 膜周型室间隔缺损患者158例,其中102例(65%)应用连续缝合法(连续缝合组),56例(35%)应用间断缝合法(间断缝合组).手术均在浅低温体外循环下矫治.结果 连续缝合组体外循环时问和主动脉阻断时间分别为(31±14)、(18±12)min,间断缝合组体外循环时间和主动脉阻断时间分别为(42±16)、(25±11)min,2组比较差异均有统计学意义(t=4.49,3.61;P均<0.01).全部患儿手术后无死亡.主要并发症有:暂时性Ⅲ度房室传导阻滞(AVB)2例,连续缝合组及间断缝合组各发生1例,均于术后1周内消失;残余分流2例,连续缝合组发生1例,间断缝合组发生1例,分流束<3 mm,术后3~6个月复诊时自行闭合;完全性右束支传导阻滞(CRBBB)9例,连续缝合组发生3例(2.94%)、间断缝合组发生6例(10.71%),其中3例于手术后1个月复查时消失,2例于手术后1年复查时消失.随访1~3年,所有患者手术效果良好.结论 连续缝合法修补膜周型大VSD具有简化手术操作技术、减少体外循环时间和主动脉阻断时间、减少心内异物存留、降低传导阻滞及残余分流发生率等优点.
目的 比較應用連續縫閤法與間斷縫閤法脩補膜週型室間隔缺損(VSD)的外科技術併進行療效評價.方法 膜週型室間隔缺損患者158例,其中102例(65%)應用連續縫閤法(連續縫閤組),56例(35%)應用間斷縫閤法(間斷縫閤組).手術均在淺低溫體外循環下矯治.結果 連續縫閤組體外循環時問和主動脈阻斷時間分彆為(31±14)、(18±12)min,間斷縫閤組體外循環時間和主動脈阻斷時間分彆為(42±16)、(25±11)min,2組比較差異均有統計學意義(t=4.49,3.61;P均<0.01).全部患兒手術後無死亡.主要併髮癥有:暫時性Ⅲ度房室傳導阻滯(AVB)2例,連續縫閤組及間斷縫閤組各髮生1例,均于術後1週內消失;殘餘分流2例,連續縫閤組髮生1例,間斷縫閤組髮生1例,分流束<3 mm,術後3~6箇月複診時自行閉閤;完全性右束支傳導阻滯(CRBBB)9例,連續縫閤組髮生3例(2.94%)、間斷縫閤組髮生6例(10.71%),其中3例于手術後1箇月複查時消失,2例于手術後1年複查時消失.隨訪1~3年,所有患者手術效果良好.結論 連續縫閤法脩補膜週型大VSD具有簡化手術操作技術、減少體外循環時間和主動脈阻斷時間、減少心內異物存留、降低傳導阻滯及殘餘分流髮生率等優點.
목적 비교응용련속봉합법여간단봉합법수보막주형실간격결손(VSD)적외과기술병진행료효평개.방법 막주형실간격결손환자158례,기중102례(65%)응용련속봉합법(련속봉합조),56례(35%)응용간단봉합법(간단봉합조).수술균재천저온체외순배하교치.결과 련속봉합조체외순배시문화주동맥조단시간분별위(31±14)、(18±12)min,간단봉합조체외순배시간화주동맥조단시간분별위(42±16)、(25±11)min,2조비교차이균유통계학의의(t=4.49,3.61;P균<0.01).전부환인수술후무사망.주요병발증유:잠시성Ⅲ도방실전도조체(AVB)2례,련속봉합조급간단봉합조각발생1례,균우술후1주내소실;잔여분류2례,련속봉합조발생1례,간단봉합조발생1례,분류속<3 mm,술후3~6개월복진시자행폐합;완전성우속지전도조체(CRBBB)9례,련속봉합조발생3례(2.94%)、간단봉합조발생6례(10.71%),기중3례우수술후1개월복사시소실,2례우수술후1년복사시소실.수방1~3년,소유환자수술효과량호.결론 련속봉합법수보막주형대VSD구유간화수술조작기술、감소체외순배시간화주동맥조단시간、감소심내이물존류、강저전도조체급잔여분류발생솔등우점.
Objective To compare the efficiency of repairing perimembranous ventricular septal defect (VSD)
with continuous stitching to that with interrupted stitching. Methods Of the 158 patients with perimembranous VSD ( 54% males) ,102 ( 65% ) patients underwent the repairing of continuous stitching (continuous group) ,and 56 patients underwent interrupted stitching (interrupted group). All the surgeries were performed under hypothermic cardiopulmonary bypass. Results The cardiopulmonary bypass time and aortic cross-clamp times were (31 ±14) mins and (18 ±12) mins in the continuous group, which was significantly less that those of (42 ± 16) mins and (25 ±11) mins in the interrupted group (t =4.49 and 3. 61 .respectively ,P <0. 05) . No case was died. The main complications involved temporary M atrioventricular block (AVB) of two cases (1 case in each group),which disappeared after 1 week. There were two remnants remaining leak (n =2) which was less than 3 mm and automatically cured after 3-6 months. Complete right bundle branch block(CRBBB) occurred in 3 cases in the continuous group and 6 cases in the interrupted group,of which 3 disappeared after 1 month and 2 disappeared after 12 months. The outcome was good in all cases after 1-3 years follow up. Conclusions Continuous stitching showed a shorter cardiopulmonary bypass and aortic cross-clamp times, and reduced the CRBBB.
