摘要
目的总结我们通过微创经心室采用国产同心伞片行膜部室间隔缺损封堵的临床经验,探讨这项技术的手术方法和适应证。方法回顾性分析2011年12月至2012年7月上海交通大学医学院附属上海儿童医学中心45例膜部室间隔缺损患者[男25例,女20例;年龄(34.1±24.2)个月;体重(12.4±9.2)kg]采用胸下小切口经心室途径封堵治疗,患者均为膜周限制性室间隔缺损,室间隔缺损基底部直径2～9mm,缺损上缘距主动脉右冠瓣≥2mm,所选伞腰直径4～10mm。在经食管超声心动图的引导下非体外循环下经右心室放入室间隔封堵伞。结果术后发生室性早搏1例,经治疗好转并未复发。其余患者术后心功能稳定,随访1～6个月,患儿伞片位置无移位,无心律失常和残余分流。结论经胸小切口采用同心伞片封堵膜部室间隔缺损安全有效,但对于初学者应该严格把握手术适应证。
Objective To summarize the clinical experience of minimally invasive perventricular device closure of perimembranous ventricular septal defects(VSD).Surgical techniques and indications were discussed.Methods From December 2011 to July 2012,45 patients[25 males and 20 females;age(34.1±24.2)months;weight(12.4±9.2)kg]with perimembranou VSD underwent perventricular concentric occluders closure with an inferior sternotomy in Shanghai Children's Medical Center affiliated to Medical College of Shanghai Jiaotong University.Restrictive VSDs were found in all the patients.The basal diameter of the VSD was 2-9 mm.The distance from superior border of VSD to right sinus valve was≥2 mm.The diameter of the occlusion device waist ranged from 4 to 10 mm.The occlusion device was deployed under echocardiographic guidance trans-right ventricular without cardiopulmonary bypass.Results Ventricular premature beat occurred in 1 patient postoperation.Arrhythmia were recovered after treatment.The other patients were stable in heart function postoperations.The duration of follow-up was 1 to 6 months.No position shift of the occlusion devices,arrhythmia or residual VSD were found during followup.Conclusions The perventricular concentric occluders closure of perimembranous VSD with an inferior sternotomy appears to be safe and feasible.The surgical indications should be strictly considered,especially to the beginners.
作者
王顺民
徐志伟
刘锦纷
严勤
张海波
郑景浩
鲁亚南
祝忠群
苏肇伉
丁文祥
WANG Shun-min;XU Zhi-wei;LIU Jin-fen;YAN Qin;ZHANG Hai-bo;ZHENG Jing-hao;LU Ya-nan;ZHU Zhong-qun;SU Zhao-kang;DING Wen-xiang(Department of Thoracic and Cardiovascular Surgery,Shanghai Children's Medical Center,Shanghai Jiaotong University School of Medicine,Shanghai 200127,China)
出处
《中华临床医师杂志（电子版）》
CAS
2012年第22期7082-7085,共4页
Chinese Journal of Clinicians(Electronic Edition)
关键词
室间隔缺损
外科手术
微创性
Heart septal defects,ventricular
Surgical procedures,minimally invasive
