不同大小动脉导管未闭封堵治疗的方法学探讨

Clinical problem related to patent ductus arteriosus in interventional therapy

目的：探讨不同大小的动脉导管未闭（PDA）封堵治疗的相关临床问题。方法：将入选的69例6个月～17岁PDA息儿分为巨大组、典型组和小型组。采用Amplatzer封堵器或可控螺旋弹簧圈封堵器进行封堵治疗，用超声心动图检查和主动脉造影进行对比研究。结果：①典型组经胸超声心动图（TTE）与主动脉造影测量PDA直径，差异无统计学意义（P〉0．05）；小型组TTE与主动脉造影测量PDA直径，差异有统计学意义（P〈0．05）。②年龄与PDA伸展性关系密切，不同年龄组的伸展性不同。结论：对于典型PDA以TTE测量值选择封堵器是可行的，对于小型PDA应该以血管造影为准，巨大PDA可以通过改变超声心动图常规切面弥补。在选择封堵器时要充分考虑到PDA的伸展性。

Objective：To explore the clinical problems related to the different sizes of patent ductus arteriosus （PDA） in interventional therapy. Method： Amplatzer ductus occlusion or the controllable spring coil was applicated in the interventional therapy for all the patients studied. All the cases were analyzed in contrast by echocardiogram and aortography. Result：（1）There was no difference to PDA detection by transthoracic echocardiography （TTE） and aortography in typical type group（P〉0.05）. There was significant difference to PDA detection by transthoracic echocardiography （TTE） and aortography in small type group（P〈0.05）. （1）The flexibility of ductus arteriosus was associated with the age of patients. Conclusion： It is feasible to choose occluder according to TTE in typical type of PDA. The occluder should be chosed on the basis of angiography in small type of PDA. It is suggested that the shape and size of the great group of PDA can be revealed more precisely by changing the examining section of TTE. The flexibility of ductus arteriosus should be considered sufficiently when occluders are chosed in interventional therapy of children with PDA.