房室间隔缺损的外科治疗

SURGICAL TREATMENT EXPERIENCE ON PATIENTS WITH ENDOCARDIAL CUSHION DEFECT

目的总结96例房室间隔缺损外科手术矫治的方法和疗效。方法2006年9月-2013年12月，广东省高州市人民医院对96例部分性／完全性房室间隔缺损患者施行了手术矫治，男57例，女39例。年龄6个月-25岁，平均6．5岁。体重6~52kg，平均18kg。其中PECD61例，CECD35例，同期行TAPVC手术3例，PS手术6例。完全性房室间隔缺损26例采用双片法矫治，9例采用改良单片法矫治。结果三组手术均成功，术后1例在监护病房发现存在室水平残余漏，经再次手术处理后治愈，1例CECD出现三度房室传导阻滞，心率42～56次／min，需要安装永久起搏器。术后B超检查示96例患者中7例有轻中度二、三尖瓣关闭不全，其余二、三尖瓣关闭佳，房或室水平分流消失。1例PECD随访至5年出现二尖瓣重度返流，行二尖瓣机械瓣置换后治愈。术后随访患者心功能I～Ⅱ级。结论应根据患者病变情况适期选择最佳方法矫治房室间隔缺损，并同期治疗合并畸形，手术关键是房室瓣的有效成形和防止房室传导阻滞。

Objective To summarize the surgical method and surgery effect in 96 cases with endocardial cushion defect. Methods From September 2006 to December 2013, 96 patients with endocardial cushion defect were performed surgery in author＇s hospital. There were 57 male and 39 female aged 6 months to 25 years with a mean age of 6. 5 years and weighed 6 to 52 kg with a mean weigh of 18 kg. Surgical procedures included PECD in 61 patients, CECD in 35 patients, TAPVC in 3 patients, PS in 6 patients. The double- patch technique was used in 26 patients and the modified single- patch technique was used in 9 patients of CECD. Results Success has been achieved in all patients, 1 patient occured residual shunt of ventricular lev- el in ICU and was cured after secondary operation. 1 CECD patient occurred III degree atrioventricular block （ heart rate between 42 bpm and 56 bpm） ,and have to install the permanent pacemaker. Mild- to- moderate mitral valve and tricuspid valve regurgitation were observed in 7 cases postoperative B ultrasonic, Others had normal closing of mitral valve and tricuspid valve and no shunt in ventricular level or Atrial lev- el. Only one case had severe mitral valve by the five years follow- up and was cured by mitra｜ valve re- placement operration. The cardiac function of all cases were in NYHA class I to ]1 in the follow- up. Con- clusion It is important to choose proper procedure and treat the combined deformities at the same time. The effect of cardiac valvuloplasty and the prevention of atrioventricular block is the essential factor to the surgical success.