天津医药

天津医药 ›› 2016, Vol. 44 ›› Issue (7): 898-901.doi: 10.11958/20160038

• 临床研究 • 上一篇    下一篇

经胸微创封堵与传统修补术治疗婴幼儿室间隔缺损的临床疗效比较

陈健1,刘建实2   

  1. 1 天津市滨海新区大港医院胸心外科（邮编 300270）；2天津市胸科医院心外科
  • 收稿日期:2016-01-27 修回日期:2016-06-22 出版日期:2016-07-15 发布日期:2016-07-15
  • 通讯作者: 刘建实 E-mail:jianshiliu@aliyun.com
  • 作者简介: 陈健（1973）， 男， 硕士， 副主任医师， 主要从事胸心外科相关研究

Comparison of clinical efficacy of minimally invasive transthoracic device closure and traditional repair with ventricular septal defect in infants

jian chen1,LIU Jianshi   

  1. 1 Department of Cardiothoracic Surgery, Binhai New Area Dagang Hospital of Tianjin, Tianjin 300270, China; 2 Department of Cardiac Surgery, Tianjin Chest Hospital
  • Received:2016-01-27 Revised:2016-06-22 Published:2016-07-15 Online:2016-07-15
  • Contact: LIU Jianshi E-mail:jianshiliu@aliyun.com

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摘要： 目的 比较经胸微创封堵术与传统修补术在治疗婴幼儿室间隔缺损（VSD）方面的临床效果。方法 回顾分析2013年10月—2015年2月天津市胸科医院心外科91例6岁以下先天性心脏病-VSD患者的资料。按照手术方式分为经胸微创VSD封堵术组（封堵组）13例和传统体外循环（CPB）下直视VSD修补术组（修补组）78例。术前心脏超声确定VSD类型、VSD边缘与主动脉瓣及三尖瓣的距离、肺动脉压以及合并其他心脏畸形等情况，术中及术后监测输血量、瓣膜反流情况、机械通气时间、重症监护室（ICU）停留时间、住院时间及费用等情况。随访12~18个月，收集心律失常、溶血、瓣膜反流及VSD残余分流的情况。结果 全部91例患者无手术死亡，封堵组中1例中转为CPB下修补术。封堵组ICU停留时间及住院时间明显少于修补组［（13.2±11.7）h vs. （77.2±55.8）h，（10.0±3.2）d vs.（15.8±6.7）d］，封堵组采用全胸骨切开及CPB 1例（7.7%），修补组全部采用全胸骨切开及CPB，输注悬浮红细胞、血浆量及机械通气时间封堵组均少于修补组（P<0.05）。术后近期以及随访期间心律失常、VSD残余分流、瓣膜反流、溶血等并发症的发生率及住院费用2组间无差别（P>0.05）。结论 经胸微创封堵术较传统修补术治疗婴幼儿VSD的近期临床疗效更好，远期疗效有待进一步观察随访。

关键词: 关键词：心脏缺损, 先天性, 室间隔缺损, 外科手术, 微创性, 婴幼儿, 治疗

Abstract: Abstract:Objective Comparison of the treatment effects of minimally invasive transthoracic device closure and traditional surgery in infant with VSD. Methods Retrospective analysis the data of 91 cases of VSD in infant under 6 years old from October 2013 to February 2015 in the Department of cardiac surgery in Tianjin Chest Hospital. According to the operation mode, patients were divided into minimally invasive transthoracic device closure of VSD (closure) group (n=13) and traditional VSD repair under CPB (repair) group (n=78). In the preoperative cardiac ultrasound was used to determine the type of VSD, the distance from the margin of VSD to aortic and tricuspid valve，Pulmonary artery pressure and other cardiac malformations. Intraoperative and postoperative monitoring included blood transfusion volume, valve regurgitation, mechanical ventilation time, ICU residence time, hospitalization time and cost, etc.. The patients were followed up for 12~18 months to collect arrhythmia, hemolysis，valve regurgitation and residual shunt of VSD. Results There were no operative mortality in 91 patients. In closure group 1 case were converted to traditional repair under CPB. The closure group was significantly less than that of the repair group in the time of ICU residence and hospitalization［(13.2±11.7) h vs. (77.2±55.8) h，(10.0±3.2) d vs. (15.8±6.7) d，P＜0.05］. In closure group 1 case(7.7%)underwent median sternotomy and CPB，all cases in repair group were median sternotomy and CPB. The infusion amount of suspended red blood cells and plasma and the time of mechanical ventilation the closure group were less than those in the repair group (P<0.05). There was no significant difference between the 2 groups in the cost of hospitalization and the incidence of complications during early postoperative and the follow-up period, including arrhythmia, VSD residual shunt, valve regurgitation, hemolysis, etc.(P>0.05). Conclusion In the comparison of the recent clinical curative effect of VSD treatment in infants , the minimally invasive transthoracic VSD device closure is better than the traditional VSD repair. Long term effects need to be further observed and followed up.

Key words: Key words:heart defects, congenital, heart septal defects, ventricular, surgical procedures, minimally invasive, infant, treatment