经胸微创封堵术治疗室间隔缺损临床效果观察

Clinical observation of transthoracic minimally invasive closure for ventricular septal defect

目的总结经胸微创封堵室间隔缺损(VSD)的经验。方法回顾分析我院于2015年3月～2017年12月经胸封堵治疗室间隔缺损患儿527例,其中男性309例,女性218例,年龄4个月-14岁,平均(2.6±1.8)岁。所有患者在全麻、气管插管下进行手术,在食道超声心动图的监测下送入封堵器,闭合室间隔缺损。结果封堵成功510例。4例因置入后主动脉瓣返流明显,改为体外循环修补;6例因残余分流改为体外循环修补;4例因通过导丝困难而改成体外循环修补;2例因三尖瓣返流而改成体外循环修补;1例因残余分流加重2d后体外循环下取出封堵器同时修补室间隔缺损。随访1-30个月,无封堵器移位,心律失常,残余分流,溶血等并发症。结论经胸微创封堵治疗室间隔缺损安全,可行,创伤小,恢复快。

Objective To summarize the Experience of transthoracic minimally invasive closure of ventricular septal defect （VSD）. Methods Retrospective analysis of our hospital in March 2015-December 2017 invasive transthoracic closure treating for 527 children with ventricular septal defect, including 309 male cases,218 female cases,aged from 4months to 14years,with an average age of （2.6±1.8） years. All patients underwent surgery under general anesthesia and endotracheal intubation,under the monitoring of the esophagus supersonic and enchanted the graph into closure,closed ventricular septal defect. Results Successful closure was achieved in 510 cases. 4 cases for placement after significantly increased aortic regurgitation, changed extracorporeal circulation; Because of the residual shunt,6 cases were repaired by extracorporeal circulation;4 cases were repaired by extracorporeal circulation because of difficulties of wire guide;2 cases were repaired by extracorporeal circulation because of tricuspid valve regurgitation ;1 case due to residual shunt obviously removed closure under extracorporeal circulation and repaired the ventricular septal defect after 2 days. Follow-up of 1 to 30 months,no closure shift, arrhythmia, residual shunt,hemolysis and other complications. Conclusion The minimally invasive transthoracic closure for treating ventricular septal defect is safe, feasible, small trauma, rapid recovery.