上海交通大学学报（医学版）

›› 2013, Vol. 33 ›› Issue (1): 62-.doi: 10.3969/j.issn.1674-8115.2013.01.012

• 论著（临床研究） • 上一篇    下一篇

膜部室间隔缺损微创手术封堵初步经验总结

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   

  1. 上海交通大学 医学院附属上海儿童医学中心心胸外科, 上海 200127
  • 出版日期:2013-01-28 发布日期:2013-02-06
  • 作者简介:王顺民（1967—）, 男, 副主任医师, 博士；电子信箱: smwang780@yahoo.com.cn。

Preliminary surgical experience of minimally invasive device closure of perimembranous ventricular septal defects

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   

  1. Department of Thoracic and Cardiovascular Surgery, Shanghai Children´s Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
  • Online:2013-01-28 Published:2013-02-06

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摘要：

目的 总结通过微创手术经心室行膜部室间隔缺损（VSD）伞片封堵的临床经验，探讨该技术的手术方法和适应证。方法 对48例膜部VSD患儿采用胸下小切口经心室途径封堵治疗。患儿均为膜周限制性VSD，VSD基底部直径2～9 mm；伞腰直径4～10 mm；45例采用同心伞，3例采用偏心伞。在经食管超声心动图的引导下经右心室放入室间隔封堵伞。结果 45例患儿术后心功能稳定，随访1～6个月，伞片位置无移位，无心律失常和残余分流。其余3例患儿发生心律失常，其中1例发生室性早搏和短阵性室性心动过速，2例发生房室传导阻滞，经治疗均好转。结论 经胸小切口行伞片封堵膜部VSD为VSD的治疗提供了一种良好的选择，应严格把握手术适应证。

关键词: 室间隔缺损, 微创, 手术

Abstract:

Objective To summarize the clinical experience of minimally invasive perventricular device closure of perimembranous ventricular septal defects (VSD), and explore the surgical techniques and indications. Methods Forty-eight patients with perimembranous VSD underwent perventricular device closure with inferior sternotomy. Restrictive perimembranous VSD were found in all the patients. The basal diameters of VSD ranged between 2 mm and 9 mm, and the diameters of the occlusion device waist ranged between 4 mm and 10 mm. Concentric occluders were used in 45 patients, and eccentric occluders were used in 3 patients. The occlusion device was deployed through right ventricle under echocardiographic guidance. Results Forty-five patients were stable in heart function after operation. Patients were followed up for 1 to 6 months, and there was no position shift of the occlusion devices, arrhythmia or residual shunt. Arrhythmia occurred in the other 3 patients after operation, including ventricular premature beat in 1 patient and atrioventricular block in the other 2 patients. All of these three patients recovered after treatment. Conclusion The perventricular device closure of perimembranous VSD with inferior sternotomy appears to be a favorable choice for the treatment of VSD, while the surgical indications should be carefully managed.

Key words: ventricular septal defects, minimal invasive, surgery