CAJ | 학술논문

目的：探讨婴幼儿膜周部室间隔缺损（VSD）行介入封堵治疗的可行性和安全性。方法2012年1月-2013年1月收治3岁以内婴幼儿单纯膜周部VSD 229例，行经皮导管介入封堵术（介入组）88例，外科手术（手术组）141例。对比两组手术成功率、主要并发症及次要并发症发生率、手术时间、术后住院时间、术后肺部感染率、住院费用等指标。结果两组患者在手术成功率、主要并发症发生率、术后住院时间、住院费用方面差异无统计学意义（P>0．05）。介入组在次要并发症发生率、手术时间等方面明显优于手术组。手术组在次要并发症多为呼吸道感染及术后24 h白细胞计数、C反应蛋白、心肌损伤标志物水平、血管活性药物评分上显著高于介入组。结论3岁以下婴幼儿膜周部VSD行经皮导管介入封堵术临床上可行，在严格把握手术指征、改良操作技术基础上，经皮导管介入封堵术策略安全可靠，优势明显，可部分替代外科手术。
목적：탐토영유인막주부실간격결손（VSD）행개입봉도치료적가행성화안전성。방법2012년1월-2013년1월수치3세이내영유인단순막주부VSD 229례，행경피도관개입봉도술（개입조）88례，외과수술（수술조）141례。대비량조수술성공솔、주요병발증급차요병발증발생솔、수술시간、술후주원시간、술후폐부감염솔、주원비용등지표。결과량조환자재수술성공솔、주요병발증발생솔、술후주원시간、주원비용방면차이무통계학의의（P>0．05）。개입조재차요병발증발생솔、수술시간등방면명현우우수술조。수술조재차요병발증다위호흡도감염급술후24 h백세포계수、C반응단백、심기손상표지물수평、혈관활성약물평분상현저고우개입조。결론3세이하영유인막주부VSD행경피도관개입봉도술림상상가행，재엄격파악수술지정、개량조작기술기출상，경피도관개입봉도술책략안전가고，우세명현，가부분체대외과수술。
Objective To study the feasibility and safety of interventional closure for the treatment of infant’s perimembranous ventricle septal defect (PmVSD). Methods During the period from Jan. 2012 to Jan. 2013, a total of 229 single PmVSD infants less than three years of age were admitted to authors ’ hospital. The infantile patients were divided into intervention group (n = 88) and surgery group (n = 141). Patients in the intervention group underwent interventional closure procedure , while patients in the surgery group received conventional cardiac surgery. The operation success rate , the main and minor complication rates, the operation time, the postoperative hospitalization days, the incidence of postoperative pulmonary infection and the medical cost were recorded , and the results were compared between the two groups. Results No statistically significant differences in the operation success rate, the main complication rate, the postoperative hospitalization days and the medical cost existed between the two groups (P > 0.05). But the minor complication rate and the operation time of the intervention group were better than those of the surgery group. In the surgery group, the minor complication was mainly the respiratory infection, which was manifested as higher leukocyte count, higher C-reactive protein level, higher myocardial damage marker level as well as higher vasoactive drug scores in 24 hours after the operation , and the above items were significantly higher than those in the intervention group. Conclusion For the treatment of infant’s perimembranous ventricle septal defect, percutaneous transcatheter closure is clinically feasible. This technique is safe and reliable with obvious advantages when the indication is strictly observed and the procedure is carefully manipulated. This treatment can partly replace the conventional surgery.