偏心型封堵器在嵴内型室间隔缺损介入治疗中的应用分析

Clinical analysis of eccentric occluder in interventional closure treatment for intracristal ventricular septal defects

目的 探讨偏心型封堵器在嵴内型室间隔缺损（VSD）介入治疗中的临床应用及术后相关并发症的规律,总结嵴内型VSD介入治疗经验,为临床手术适应证的选择提供参考.方法 对2009年1月—2015年2月在南京医科大学附属儿童医院心脏中心进行介入治疗的65例嵴内型VSD患儿临床资料进行回顾分析,按所选择封堵器大小分为A组（封堵器型号≤6 mm,n=29）和B组（封堵器型号≥7 mm,n=36）,分析两组术前合并肺动脉高压、主动脉瓣脱垂、返流情况、手术时间、X线曝光时间及术后并发症等情况.结果 A组（封堵器型号≤6 mm）29例术前未合并肺动脉高压,术后严重并发症1例,手术时间（62.4±13.8）min、X线曝光时间（13.2±5.6）min;B组（封堵器型号≥7 mm）36例术前合并肺动脉高压7例,术后严重并发症10例,手术时间（84.1±16.7）min,X线曝光时间（20.5±7.4）min,两组差异均有统计学意义（P值均〈0.05）.A组和B组术后轻微并发症分别有6例和9例,差异无统计学意义（P〉0.05）.结论 随嵴内型VSD直径的增大,所使用封堵器型号相应增大,手术时间及X线曝光时间明显延长,术后严重并发症如主动脉瓣损伤、完全性左束支传导阻滞等发生率偏多,因此对需选择偏心型封堵器型号≥7 mm的病例介入封堵治疗时应谨慎.

Objective To investigate the clinical application of eccentric occluder in the treatment of intracristal ventricular septal defects （VSD） and its complications as well as to summarize the experience of interventional therapy on intracristal VSD in order to provide the basis for the selection of surgical indications in the future practices. Methods The clinical data of 65 patients with intracristal ventricular septal defects underwent interventional treatment in the Heart Center of the Affiliated Children＇s Hospital of Nanjing Medical University from January 2009 to February 2015 were retrospectively analyzed. All the patients were divided into two groups according to the size of the occluder： Group A （the size of occluder ≤6 mm, n = 29） and Group B （the size of occluder ≥7 mm, n = 36）. Then the relevant data related to the treatment of the 2 groups was analyzed and compared. Results The number of patients complicated with pulmonary hypertension before surgery and major complications after surgery, operation time, X-ray exposure time of the group A and group B was 0 vs. 7, 1 vs. 10, （62. 4 ± 13. 8） min vs. （84. 1 ± 16. 7） min, （13. 2 ± 5. 6 ） min vs. （20. 5 ± 7. 4） min, respectively, showing significant difference （all P values 〈0. 05）, while there was no statistical significance in minor complications after surgery between the two groups （P 〉 0. 05）. Conclusions With the diameter of intracristal VSD increasing, the size of the occluder employed in the operation is enlarged, and as this is true of the difficulty and risk of operation and postoperative complications. Therefore, it should be more cautious in the treatment of intracristal ventricular septal defects in patients who undergo the interventional therapy with eccentric occluder ≥7 mm.