经胸封堵先天性室间隔缺损临床疗效

Clinical efficacy for transthoracic closure of congenital ventricular septal defect

目的通过与经皮室间隔缺损(VSD)封堵术进行比较,评估经胸封堵先天性VSD的临床疗效,并探讨手术适应证,禁忌证及并发症。方法回顾性分析2012年4月至2016年4月在湘雅二医院接受经胸VSD封堵术(经胸组)治疗的328例患儿及接受经皮介入VSD封堵术(经皮组)290例患儿的临床资料。对比分析两组手术成功率、疗效、并发症及封堵失败原因。结果经胸组手术总成功率高于经皮组[93.6%(307/328)vs 86.6%(251/290),P<0.01]。封堵失败病例均改行体外循环下VSD修补术。术后住院时间及机械通气时间经胸组多于经皮组(P均<0.01);经胸组住院费用与经皮组无明显差异(P>0.05);经胸组手术时间低于经皮组(P<0.05);经胸组术后不完全右束支阻滞新发生率明显高于经皮组(P<0.05),左前分支阻滞新发生率经胸组明显低于经皮组(P<0.05),两组完全右束支阻滞、三度房室传导阻滞新发生率无明显差异(P均>0.05)。术后早期残余分流发生率经胸组(4.23%)和经皮组(3.99%)相比无明显差异(P>0.05)。结论经胸VSD封堵术拓宽了经皮VSD封堵术的适应证,且可避免患儿和医护人员X线损害,早中期结果显示该术式治疗有适应证的VSD安全、有效。

Objective To evaluate the clinical efficacy of transthoracic closure for congenital ventricular septal defect（VSD） by comparing with percutaneous（transcathete） closure and explore the surgical indications,contraindications and complications. Methods Retrospective analysis was made on clinic data of 328 pediatric patients with VSD receiving transthoracic closure of VSD and 290 pediatric patients with VSD receiving percutaneous intervention closure of VSD in Central South University Xiangya Second Hospital between April 2012 and April 2016. The surgical success rate,curative effect,complication and failure reason were analyzed in two groups. Results The total success rate in transthoracic closure group was significantly higher than that in percutaneous closure group[93. 6%（307/328） vs 86. 6%（251/290）,P〈0. 05]. For the cases of closure failure,the VSD closure was changed into VSD repair under cardio-pulmonary bypass.Postoperative hospital stay and mechanical ventilation time in transthoracic closure group were significantly more than those in percutaneous closure group（all P〈0. 05）. There was no significant difference in hospitalization expenses between two groups（P〉0. 05）. The operation time in transthoracic closure group was significantly lower than that in percutaneous closure group（P〈0. 05）. The new incidence of incomplete right bundle branch block in transthoracic closure group was significantly higher than that in percutaneous closure group（P〈0. 05）. The new incidence of left anterior hemiblock（LAH） in transthoracic closure group was significantly lower than that in percutaneous closure group（P〈0. 05）. There were no significant differences in new incidences of complete right bundle branch block and Ⅲ °atrio-ventricular conductive block between two groups（all P〉0. 05）. There was no significant difference in incidence of early postoperative residual shunt between transthoracic closure group and percutaneous closure group（4. 23% vs 3. 99%,P〉0. 05）. Conclusion Transthoracic closure of VSD broadens the indications of percutaneous closure. Early and avoids X ray damage to children and medical care personnel. The mid-term results show that transthoracic VSD closure is a safe and effective treatment method for the VSD with indication.