超声心动图引导下行经皮动脉导管未闭封堵术的临床研究

Clinical investigation of percutaneous closure of patent ductus arteriosus under echocardiography guidance

目的探讨使用超声心动图作为唯一影像学工具行经皮动脉导管未闭(PDA)封堵术的安全性和有效性。方法回顾性分析2013年8月至2016年4月在中国医学科学院阜外医院接受单纯超声心动图引导下经皮PDA封堵术200例患者的临床资料。根据封堵血管径路的不同,将患者分为经股动脉途径组(n=143)和经股静脉途径组(n=57)。其中经股动脉途径组,男42例、女101例,年龄(3.20±5.63)岁;经股静脉途径组,男10例、女47例,年龄(7.30±11.36)岁。所有患者术后1个月在门诊随访超声心动图、胸部X线片及心电图。结果 200例患者均成功置入封堵器。两组患者的性别、住院时间、封堵器脱落率差异均无统计学意义(P>0.05)。与经股静脉途径组相比,经股动脉途径组患者年龄较小[(3.20±5.63)岁vs.(7.30±11.36)岁,P<0.001]、体质量较轻[(14.25±11.54)kg vs.(24.25±19.14)kg,P<0.001],PDA直径和封堵器直径较短[(3.06±0.79)mm vs.(5.93±0.68)mm,P<0.001;(5.43±1.00)mm vs.(12.14±0.54)mm,P<0.001],但住院费用较高[(32 108.2±3 100.2)元vs.(25 120.7±3 534.1)元,P<0.001]。经股静脉途径组有1例患者术中因导丝通过PDA困难而改行放射线引导下封堵成功。经股动脉途径组有1例患者(PDA直径4.5 mm)术后1 d封堵器脱落,急诊开胸行封堵器取出后经胸动脉导管封堵术封堵成功。所有患者均顺利出院。两组患者在术后随访期内均无封堵器脱落、残余分流、心包积液、左肺动脉狭窄等并发症发生。结论单纯超声心动图引导下经皮PDA封堵术安全有效,但应注意根据PDA的解剖特点选择合适的血管途径。

[Abstract] Objective Toassesstheefficacyandsafetyofpercutaneousclosureofpatentductusarteriosus（PDA） solely under echocardiography guidance. Methods We retrospectively analyzed the clinical data of 200 patients who received the percutaneous closure of PDA under echocardiography guidance in Fuwai Hospital from August 2013 to April 2016. According the different approach, they were divided into 2 groups： a femoral artery approach group （n=143） and a femoral vein approach group （n=57）. In the femoral artery approach group, there were 42 males and 101 females aged 3.20~5.63 years. In the femoral vein group, there were 10 males and 47 females aged 7.30~11.36 years. All Patients were treated by percutaneous PDA closure solely under echocardiography guidance. The follow-up was performed at one month after the operation by echocardiography, chest radiograph and electrocardiogram. Results All 200 patients were successfully treated with percutaneous closure of PDA. The patients＇ gender, in-hospital stay, rates of occluder detachment were similar between the two groups （P〉O.05）. Compared with the femoral vein approach group, the femoral artery approach group had a younger age （3.20±5.63 years vs. 7.30±11.36 years, P〈0.001）, less body weight （14.25±11.54 kg vs. 24.25±19.14 kg, P〈0.001） and shorter diameter of PDA （3.06±0.79 mm vs. 5.93±0.68 mm, P〈0.001） and PDA ocduders （5.43±1.00 mm vs. 12.14±0.54 mm, P〈0.001）, but had higher hospitalization expenses （32 108.2±3 100.2 yuan vs. 25 120.7±3 534.1 yuan, P〈0.001）. In the femoral vein approach group, one patient was closed under radiation guidance because guide wires could not pass through PDA. One patient in the femoral artery approach group suffered from occluder detachment at one day after operation and was cured by transthoracic minimally invasive PDA occlusion. There were no complications of occluder detachment, residual shunt, pericardial effusion or left pulmonary stenosis during the follow-up. Conclusion Echocardiography-guided percutaneous PDA closure is safe and effective, while the proper interventional approach should be chosen by the anatomical features of PDA.