婴幼儿室间隔缺损修补术后残余分流的自发愈合

Spontaneous Closure of Residual Ventricular Septal Defect after Surgical Repair in Infant

目的探讨婴幼儿室间隔缺损(VSD)修补术后残余分流的预后。方法连续选取2008年1～6月上海交通大学医学院附属上海儿童医学中心407例(男255例、女152例)婴幼儿VSD患者,1岁以下273例,1～2岁88例,2～3岁46例,均采用戊二醛固定的自体心包补片连续缝合法进行修补。结果 407例患者中29例出现小残余分流(≤0.4cm),残余分流率在1岁以下、1～2岁、2～3岁各年龄段之间差异无统计学意义(χ2=0.054,P=0.973)。随访29例,随访1.5个月～2年,26例患者残余分流愈合,其中23例为膜周型,残余分流位于VSD隔瓣下或VSD上、下缘,3例为肺动脉瓣下型;有3例残余分流患者随访中始终不愈合,残余分流无明显变化,均位于VSD上缘,无需再次手术。残余分流率在各类型VSD之间差异无统计学意义(χ2=1.035,P=0.596)。结论婴幼儿VSD修补术后小于0.4cm的残余分流大部分可以自发愈合。

Objective To investigate the prognosis of residual shunt after surgical repair in infants. Methods We selected 407 consecutive infant patients （255 males and 152 females） with venticular septal defects（VSD） between January 2008 and June 2008 in Shanghai Children＇s Medical Center, Shanghai Jiaotong University. Of the patients, 273 were less than 1 year old, 88 were 1-2 years old, and 46 were 2-3 years old. All of whom underwent surgical repair of the ventricular septal defect with autologous pericardial defect treated by glutaraldehyde. Results Of the 407 patients, 29 had residual ventricular septal defects, there was no significant difference among age groups in the rate of residual shunts （x2= 0. 054, P = 0. 973）. Twenty-nine patients were followed-up, and in the follow-up period of 1. 5 months to 2 years post-surgery, 26 patients had spontaneous closure, while the other 3 patients did not heal. None of the patients needed reoperation. There was no significant difference among age groups or type of ventricular septal defect in the rate of residual shunts （x2 = 1. 035, P = 0. 596）. Conclusions Postsurgical residual ventricular septal defects smaller than 0.4 cm will close spontaneously in most infants.