经胸微创封堵与传统修补术治疗婴幼儿室间隔缺损的临床效果比较

Comparison of clinical efficacy of minimally invasive transthoracic device closure and traditional repair with ventricular septal defect in infants

目的比较经胸微创封堵术与传统修补术在治疗婴幼儿室间隔缺损(VSD)方面的临床效果。方法回顾分析2013年10月—2015年2月天津市胸科医院心外科91例6岁以下VSD患者的资料。按照手术方式分为经胸微创VSD封堵术组(封堵组)13例和传统体外循环(CPB)下直视VSD修补术组(修补组)78例。术前心脏超声确定VSD类型、VSD边缘与主动脉瓣及三尖瓣的距离、肺动脉压以及合并其他心脏畸形等情况,术中及术后监测输血量、瓣膜反流、机械通气时间、重症监护室(ICU)停留时间、住院时间及费用等情况。术后定期随访,收集心律失常、溶血、瓣膜反流及VSD残余分流的情况。结果全部91例患者无手术死亡,封堵组中1例中转为CPB下修补术。封堵组ICU停留时间及住院时间明显少于修补组[(13.2±11.7)h vs.(77.2±55.8)h,(10.0±3.2)d vs.(15.8±6.7)d],封堵组采用全胸骨切开及CPB 1例(7.7%),修补组全部采用全胸骨切开及CPB,封堵组输注悬浮红细胞、血浆量及机械通气时间均少于修补组(P<0.05)。术后近期以及随访期间心律失常、VSD残余分流、瓣膜反流、溶血等并发症的发生率及住院费用2组间差异无统计学意义(P>0.05)。结论经胸微创封堵术较传统修补术治疗婴幼儿VSD的近期临床疗效更好,远期疗效有待进一步观察随访。

Objective To compare the treatment effects between minimally invasive transthoracic device closure and traditional surgery on ventricular septal defect (VSD) in infants. Methods Data of 91 infants of VSD, who were less than 6 years old, were retrospectively analyzed from October 2013 to February 2015 in the department of cardiac surgery in Tianjin Chest Hospital. According to the operation mode, patients were divided into minimally invasive transthoracic device closure of VSD (closure) group (n=13) and traditional VSD repair under cardiopulmonary bypass (CPB, repair group, n=78) group. The preoperative cardiac ultrasound was used to determine the type of VSD, the distance from the margin of VSD to aortic and tricuspid valve, pulmonary artery pressure and other cardiac malformations. The intraoperative and postoperative monitoring included blood transfusion volume, valve regurgitation, mechanical ventilation time, intensive care unit (ICU) residence time, hospitalization time and hospitalization cost. The patients were followed up regularly after surgery to collect data including arrhythmia, hemolysis, valve regurgitation and residual shunt of VSD. Results There was no operative mortality in 91 patients. In closure group 1 case was converted to traditional repair surgery under CPB. There were significantly less values in ICU residence time and hospitalization time in closure group than those of the repair group[(13.2±11.7) h vs. (77.2±55.8) h, and (10.0±3.2) d vs. (15.8± 6.7) d, P<0.05]. In closure group 1 case (7.7%) underwent median sternotomy and CPB. All cases in repair group underwent median sternotomy and CPB. The infusion amount of suspended red blood cells, plasma and the time of mechanical ventilation were less in closure group than those in repair group (P < 0.05). There were no significant differences in the incidence of complications during early postoperative and the follow-up period, including arrhythmia, VSD residual shunt, valve regurgitation, hemolysis, and the cost of hospitalization between two groups (P>0.05). Conclusion In the comparison of the recent or short-term clinical curative effect of VSD treatment in infants, the minimally invasive transthoracic VSD device closure is better than the traditional VSD repair treatment. Long term effects need to be further observed and followed up.