外科手术与介入封堵治疗小儿动脉导管未闭的对照研究

Comparative study of surgical and interventional closure for the treatment of patent ductus arteriosus in children

目的比较不同手术方式对小儿动脉导管未闭的治疗效果。方法回顾性分析2016年1月1日至2017年12月31日于我院胸心外科行手术治疗的先天性动脉导管未闭患儿38例为观察组(动脉导管未闭切断缝合术12例,动脉导管未闭结扎术26例,男14例、女24例,年龄0.08~8.67岁)。随机抽取同期于心内科行介入封堵术的动脉导管未闭患儿38例为对照组(均行介入封堵术,男17例、女21例,年龄0.50~5.42岁)。比较两组患儿临床效果。结果观察组手术时间、术后住院时间、输血情况均长于或多于对照组,差异有统计学意义(P<0.05),而两组患儿术中出血量、术后并发症情况方面差异均无统计学意义(P>0.05)。结论单一动脉导管未闭或者管径较小的患儿,行介入封堵术创伤更小、恢复更快,而对于低体重、早产儿、合并有其他心内畸形或导管粗大、合并中-重度肺动脉高压情况的动脉导管未闭的患儿,外科手术更加合适。

Objective To study effect of different surgical treatments for patent ductus arteriosus in children. Method A total of 38 patients with patent ductus arteriosus who underwent surgical treatment of cardiothoracic surgery between January 2016 and December 2017 in our hospital were as an observation group (12 patients with severing suture, 26 patients with ligation, 14 males and 24 females, aged 0.08–8.67 years). In the same period, 38 patients with patent ductus arteriosus who underwent interventional closure in the Department of Cardiology were as a control group (17 males and 21 females, aged 0.50–5.42 years). The clinical effectiveness of the two groups was compared. Results The operation time, postoperative hospital stay, and blood transfusion rate in the observation group were higher than those in the control group with statistical differences (P<0.05). There was no statistical difference in intraoperative blood loss and complications between the two groups. Conclusions In patients with a single patent ductus arteriosus or a small catheter, interventional closure of the patent ductus arteriosus is less trauma and faster recovery. But in patients with lower weigh, premature, other intracardiac malformations, large catheter, moderate or severe pulmonary hypertension, the surgery is better.