婴幼儿多发性室间隔缺损中肌部室间隔缺损的外科治疗

Surgical Treatment of Muscular Ventricular Septal Defect in Infants with Multiple Ventricular Septal Defects

目的探讨婴幼儿多发性室间隔缺损(VSD)中肌部室间隔缺损(muscular ventricular septal defect,MVSD)的外科治疗策略。方法回顾性分析2010年1月至2012年4月上海儿童医学中心46例婴幼儿多发性VSD经外科手术治疗的临床资料,其中男24例,女22例;年龄(8±6)个月;体重(6.1±1.9)kg。全组患者进行一期修补,其中10例患儿的MVSD于术中未能探及,且未予以处理;19例患儿的MVSD采用手术缝合;12例患儿采用直视杂交封堵MVSD;5例患儿经右心室杂交封堵MVSD。术后随访定期复查胸部X线片、心电图、心脏彩色超声心动图,观察患者MVSD封堵情况,有无残余分流。结果 46例多发性VSD患儿全部存活,无围术期死亡。术后3例直视封堵者延迟关胸,1例直视封堵者出现心功能不全。随访46例,随访时间1～17个月。23例患儿于随访期间出现不同程度的残余分流,大多数有残余分流的患儿MVSD直径<4 mm。均在继续随访观察中。结论多发性VSD中MVSD的处理可根据术中的具体情况选取合适的手术策略,均能取得较好的疗效。

Objective To investigate surgical strategy for the treatment of muscular ventricular septal defect （MVSD） in infants with multiple ventricular septal defects （VSD）. Methods Clinical data of 46 infants with multiple VSD who underwent surgical repair in Shanghai Children＇s Medical Center from January 2010 to April 2012 were retro- spectively analyzed. There were 24 males and 22 females with their age of 8±6 months and body weight of 6.1 ± 1.9 kg. All the patients received one-stage surgical repair, among whom MVSD of 10 patients was not found and repaired during the surgery. MVSD was repaired by surgical suture in 19 patients, hybrid repair under direct vision in 12 patients, and hybrid repair via the right ventricle in 5 patients. All the patients were regularly followed up after discharge by chest X-ray, ECG and color Doppler echocardiography to observe the closure of MVSD and the presence of residual shunt. Results All the 46 patients with multiple VSD survived their surgery without perioperative death, Three patients undergoing hybrid repair under direct vision received delayed sternal closure. One patient undergoing hybrid repair under direct vision had postoperative cardiac dysfunction. All the 46 patients were followed up for 1-17 months. Twenty-three patients had resid- ual shunt of varying degrees during follow-up, and most of the MVSD of patients with residual shunt were 〈 4 mm, who were receiving further follow-up and evaluation. Conclusion Appropriate surgical strategies can be applied according to specific surgical views during the operation for the treatment of MVSD in infants with multiple VSD, and satisfactory clinical outcomes can be achieved.