多发室间隔缺损外科手术方法探讨

Discussion of surgical methods of multipal ventricular septal defects

目的:探讨多发室间隔缺损外科手术方法。方法:回顾分析15例多发室间隔缺损患者的外科手术治疗结果。切口入路共有4类:(1)右房切口;(2)右室切口;(3)左室切口;(4)右室流出道联合左室切口。分析比较不同入路的手术结果。结果:无手术死亡。发生残余分流3例,无须再次手术治疗。结论:本组病例临床结果良好,但残余漏的发生率仍比较高,术中应常规行经食道超声检查。手术切口选择应根据室缺的位置,尽可能采用右房或右室切口,尽量避免左室切口。

Objective： To discussion of the methods and results of the surgical treatment of multipal ventrieular septal dofects（VSDs）. Methods： The clinical data of 15 patients with multipal ventrieular septal defects were analysed retrospectively. We repaired the apical VSDs via 4 kinds of approach： （1）fight atrium; （2）right ventrieulotomy ; （3）left ventriculotomy ; （4）the incision of the out tract of right ventricle combined with left ventriculotomy. Analyze and compare the operative effect between different approach. Results：None died in pedoperative period.There was residual VSI）s in 3 patients, they did not need reoperation. Conclusions：The operative outcome of patients with multipal VSDs is satisfied al- though the occurrence rate of residual VSDs is higher.The intraoperative transesopheageal echocardiography（TEE） should be regular. Surgical approach should be based on the actual site of the VSDs at operation. We should repair the VSI）s via the right atrium as possible, and via the apical fight ventriculotomy if needed and try to avoid left ventrieulotomy.