经胸壁微创封堵术治疗小儿室间隔膜部缺损的临床研究

The clinical research of minimally invasive closure through the chest wall curing children ventricular septal defect

目的比较经胸壁微创封堵术及开胸手术治疗小儿室间隔缺损的临床疗效。方法回顾性收集2014年1月至2015年1月收治112例实施手术治疗的室间隔膜部缺损患儿的临床资料,将其分为观察组和对照组。观察组54例实施胸壁微创封堵术,在食管或经胸超声引导下经胸置入封堵器以闭合室间隔缺损。对照组58例实施直视下修补术。观察两组患者的手术时间、气管插管时间、住院时间、输血率和术后并发症情况。结果两组患儿均手术成功,无死亡病例。观察组患儿的手术时间、气管插管时间及住院时间均低于对照组(P<0.05)。观察组患儿术中输注冰冻血浆或红细胞悬液者4例,输血率为7.4%;对照组患儿术中输注冰冻血浆或红细胞悬液者54例,输血率为100%,观察组的输血率明显低于对照组(P<0.05)。观察组总并发症率为27.8%,对照组总并发症率为43.1%,两组患儿术后并发症发生率无显著差异(P>0.05)。随访12个月,两组患儿均未出现心律失常,对照组2例残余分流于术后1个月消失。结论经胸壁微创封堵术治疗小儿膜部室间隔缺损是一种微创、简便及安全的方法,近期疗效显著。

Objective To compare the efficacy between through the chest wall minimally invasive closure via ultrasound and open thoracic surgery treatment for children ventricular septal defect. Methods 112 cases were retrospectively collected from January 2014 to January 2014 in our department who received surgery treatment ventricular septal defect,and were divided into two groups： the observation group with 54 cases,who received through chest wall minimally invasive closure via chest with ultrasound guided,and the control group with 58 cases,who received open thoracic surgery. Their operation time,endotracheal intubation time,hospital stay,blood transfusion rate,postoperative complications,and follow- up of patients were regularly observed. Results All operations were successful,with no death. The operating time,endotracheal intubation time and hospital stay in the observation group was lower than those in the control group（ P〈0. 05）. 4 cases received infusion of frozen plasma or red blood cell suspension in the observation group,blood transfusion rate was 7. 4%. In the control group,54 cases received frozen plasma infusion or red blood cell suspension and its blood transfusion rate was 100%. The rate of blood transfusion in the observation group was obviously lower than that in the control group（ P〈0. 05）. The total complication rate was 27. 8% and 43. 1% in observation group and control respectively,there was obvious difference between the two groups（ P〉0. 05）. After followed up for 12 months,there was no arrhythmia occurred in two groups. In open surgery group,2 cases of residual shunt disappear in postoperative 1 month. Conclusion Through the chest wall minimally invasive closure via ultrasound to treat children ventricular septal defect is a minimally invasive,simple and safe method,and the recent curative effect is effective.