中华小儿外科杂志
中華小兒外科雜誌
중화소인외과잡지
CHINESE JOURNAL OF PEDIATRIC SURGERY
2012年
12期
886-889
,共4页
室间隔缺损%外科手术,微创性%体外循环
室間隔缺損%外科手術,微創性%體外循環
실간격결손%외과수술,미창성%체외순배
Heart septal defect,ventricular%Surgical procedures,minimally invasive%Extracorporeal circulation
目的 总结2个儿童心脏中心食道超声经胸微创室间隔缺损(ventricular septal defect,VSD)封堵术的临床经验.方法 回顾性分析2008年7月至2011年7月浙江大学医学院附属儿童医院及宁波市妇女儿童医院2个儿童心脏中心行食道超声经胸微创VSD封堵术142例的临床资料.其中,膜周部VSD 95例,嵴内型VSD 37例,肌部VSD 10例.VSD直径:经胸超声下3.0～8.5 mm,平均(4.7±0.8)mm;食道超声下2.5～8.0 mm,平均(4.3±1.0) mm.结果 142例中140例当时封堵成功(97.2％),其中1例(0.7％)术后第5天出现Ⅲ°房室传导阻滞、阿斯综合征,术中转体外循环(CPB)下封堵器取出+VSD修补,术后逐渐恢复窦性心律；1例(0.7％)嵴内型肺动脉瓣下VSD当时封堵成功,术后5h出现封堵器脱落嵌于左肺动脉,急诊CPB下主肺动脉切开封堵器取出+VSD修补.选用膜周部对称伞85例,偏心伞47例,肌部伞8例.3例(2.1％)新出现微量三尖瓣反流.9例(6.4％)术后出现不完全性右束支传导阻滞,1例(0.7％)术后出现Ⅱ°Ⅰ型房室传导阻滞伴心室内差异传导,经过甲基强的松龙静滴后转为窦性心动过速,偶发房早.术后在监护室当天拔气管插管,第2天转回普通病房.平均(7.1±2.2)d出院.术后133例(95.0％)随访至今,分别在术后1个月、3个月及每年复查心电图、胸片及心脏超声,最长已36个月.无死亡,未见伞片移位、未见残余分流及瓣膜反流加重,无严重心律失常等并发症.结论 经胸微创室间隔缺损封堵术是一种微创手术治疗方法,操作简单,安全性高,具有推广应用价值.
目的 總結2箇兒童心髒中心食道超聲經胸微創室間隔缺損(ventricular septal defect,VSD)封堵術的臨床經驗.方法 迴顧性分析2008年7月至2011年7月浙江大學醫學院附屬兒童醫院及寧波市婦女兒童醫院2箇兒童心髒中心行食道超聲經胸微創VSD封堵術142例的臨床資料.其中,膜週部VSD 95例,嵴內型VSD 37例,肌部VSD 10例.VSD直徑:經胸超聲下3.0～8.5 mm,平均(4.7±0.8)mm;食道超聲下2.5～8.0 mm,平均(4.3±1.0) mm.結果 142例中140例噹時封堵成功(97.2％),其中1例(0.7％)術後第5天齣現Ⅲ°房室傳導阻滯、阿斯綜閤徵,術中轉體外循環(CPB)下封堵器取齣+VSD脩補,術後逐漸恢複竇性心律；1例(0.7％)嵴內型肺動脈瓣下VSD噹時封堵成功,術後5h齣現封堵器脫落嵌于左肺動脈,急診CPB下主肺動脈切開封堵器取齣+VSD脩補.選用膜週部對稱傘85例,偏心傘47例,肌部傘8例.3例(2.1％)新齣現微量三尖瓣反流.9例(6.4％)術後齣現不完全性右束支傳導阻滯,1例(0.7％)術後齣現Ⅱ°Ⅰ型房室傳導阻滯伴心室內差異傳導,經過甲基彊的鬆龍靜滴後轉為竇性心動過速,偶髮房早.術後在鑑護室噹天拔氣管插管,第2天轉迴普通病房.平均(7.1±2.2)d齣院.術後133例(95.0％)隨訪至今,分彆在術後1箇月、3箇月及每年複查心電圖、胸片及心髒超聲,最長已36箇月.無死亡,未見傘片移位、未見殘餘分流及瓣膜反流加重,無嚴重心律失常等併髮癥.結論 經胸微創室間隔缺損封堵術是一種微創手術治療方法,操作簡單,安全性高,具有推廣應用價值.
목적 총결2개인동심장중심식도초성경흉미창실간격결손(ventricular septal defect,VSD)봉도술적림상경험.방법 회고성분석2008년7월지2011년7월절강대학의학원부속인동의원급저파시부녀인동의원2개인동심장중심행식도초성경흉미창VSD봉도술142례적림상자료.기중,막주부VSD 95례,척내형VSD 37례,기부VSD 10례.VSD직경:경흉초성하3.0～8.5 mm,평균(4.7±0.8)mm;식도초성하2.5～8.0 mm,평균(4.3±1.0) mm.결과 142례중140례당시봉도성공(97.2％),기중1례(0.7％)술후제5천출현Ⅲ°방실전도조체、아사종합정,술중전체외순배(CPB)하봉도기취출+VSD수보,술후축점회복두성심률；1례(0.7％)척내형폐동맥판하VSD당시봉도성공,술후5h출현봉도기탈락감우좌폐동맥,급진CPB하주폐동맥절개봉도기취출+VSD수보.선용막주부대칭산85례,편심산47례,기부산8례.3례(2.1％)신출현미량삼첨판반류.9례(6.4％)술후출현불완전성우속지전도조체,1례(0.7％)술후출현Ⅱ°Ⅰ형방실전도조체반심실내차이전도,경과갑기강적송룡정적후전위두성심동과속,우발방조.술후재감호실당천발기관삽관,제2천전회보통병방.평균(7.1±2.2)d출원.술후133례(95.0％)수방지금,분별재술후1개월、3개월급매년복사심전도、흉편급심장초성,최장이36개월.무사망,미견산편이위、미견잔여분류급판막반류가중,무엄중심률실상등병발증.결론 경흉미창실간격결손봉도술시일충미창수술치료방법,조작간단,안전성고,구유추엄응용개치.
Objective To introduce the minimally invasive experiences on perventricular device closure of ventricular septal defects (VSDs) under transesophageal echocardiography (TEE) guidance in two children hospital heart centers.Methods 142 cases of VSDs undertook perventricular device closure under TEE guidance in two centers between July 2007 and July 2011,in which perimembranous VSDs was found in 95 cases,intracristal VSDs in 37 cases and muscular VSDs in 10 cases.Their clinical data was retrospectively analyzed.The diameter of the VSD ranged from 3.0 to 8.5 mm (mean4.7 mm) by TTE,and ranged from 2.5 to 8.0 mm (mean 4.3 mm) by TEE.Results The procedures was completed successfully in 140 cases (97.2％).1 patient (0.7％) was complicated with Ⅲ atrialventricular conduction block in post-operation 5th day.VSD was closed with CPB in the secondary operation,the patient gradually reached to sinus rhythm in post-operation.The device in 1 patient (0.7％) fell off and located in the left pulmonary artery after the operatior.The device was taken out and followed by VSD closure with CPB in the secondary operation.Concentric devices were used in 93cases and eccentric devices were used in 47 cases.During fellow-up,no clinically significant complications were found.Conclusions The minimally invasive penventricular device closuer of VSD without CPB is a safe and effective therapy in children.It should be encouraged in clinical practice.
