经皮穿刺动脉导管闭合术的临床应用及并发症的处理

Clinical Use and Complication Management of Percutaneous Closure of Patent Ductus Arteriosus

采用改进的Porstmann法对8例动脉导管未闭（PDA）患者实施经皮穿刺堵塞术。以彩色多普勒，球囊导管探测PDA大小，结合导管尺测量塞子并实施堵塞术。6例关闭成功，其血流动力学各参数均明显改善或恢复正常。随访2～4年无栓子移位或再分流发生。失败2例：1例未闭导管呈反漏斗型，塞子脱入肺动脉，经送至股静脉并切开取出；另1例系股动脉太细而不能送入选定的塞子。因此，严格选择适应证是手术成功的关键。

By using improved Porstmann method,the Percutaneous closure of patent ductus arteriosus (PDA) was performed in & patients aged from 7 to 39 (mean 24. 6± 8. 9) years. The colour Doppler,balloon exploration of the detective and a catheter scale examination of the foam plug were used for choice of patients,measurement of PDA dilated diameter and plug closure. Successful occlusion was achieved in 6 cases. The shunts from aotic artery to pulmonary artery were blocked as soon as the plug fixed in PDA. The pressure of pulmonary artery and right ventricle decreased (2.9 ± 0. 9 vs 1. 6 ± 1. 3, P< 0. 01 ) and the cardic index increased (2.7± 0. 7 vs 3. 6± 0. 5,P<0. 05) significantly after occlusion. The laboratory parameter improved and return to normal. There were no plug displacement and recanalization in 2~4 years follow up. The bradycardia, hypotension or even shock would occure at the time of about 30 minuts after the closure,but this complication can be avoided by early management. Two cases were unsuccessful. One's plug dislocated into pulmonary artery through inverse funnel shaped PDA. The plug was pushed to femoral vein with a catheter and taken it off from there by incised the vein. The other one's femoral artery was thiner than PDA and the chosen plug could not be placed into the artery. So the choice of suitable patient was important.