先天性心脏病室间隔缺损156例自发性闭合情况观察

Spontaneous closure of ventricular septal defect in 156 patients with congenital heart disease

目的:观察先天性心脏病室间隔缺损(VSD)的自发闭合(SC)情况,探讨VSD的治疗时机。方法:选取符合条件的单纯VSD患儿156例,将其按照缺损部位分为膜周部VSD组(112例)、漏斗部VSD组(20例)和肌部VSD组(24例),膜周VSD组又根据有无膜部瘤形成分为膜部瘤形成组(59例)以及无膜部瘤组(53例);按照观察期间患儿发生SC或手术闭合分为手术组(39例)和SC组(88例),在观察期结束时,对比两组之间缺损大小是否有统计学差异。所有患儿于入选时、1个月、6个月以及之后每半年检查超声心动图,追踪至学龄前,观察6年内VSD的SC率和SC发生时间。结果:随访6年,肌部VSD组自愈最多(87.5%),膜周部VSD组次之(57.14%),漏斗部VSD组最少(15.00%),3组间差异具有统计学意义(P<0.05);肌部VSD组SC发生时间最早[(1.9±1.2)岁],膜周部VSD组次之[(2.3±1.5)岁],漏斗部VSD组最晚[(2.7±0.8)岁],3组间差异具有统计学意义(P<0.05)。膜部瘤形成组SC率显著高于无膜部瘤组(84.48%∶28.30%,P<0.05)。另有39例患儿在此期间进行了手术闭合治疗,其中膜部瘤形成7例,无膜部瘤19例,漏斗部12例,肌部1例;手术治疗组的患儿VSD缺损直径为(6.3±3.6) mm,SC组的VSD缺损直径为(3.9±1.5) mm,两者差异有统计学意义(P<0.05)。结论:缺损较小的VSD患儿在出生后6年内有一半以上能自发性闭合,尤其是肌部VSD和膜部瘤形成VSD大部分能够自行愈合;缺损较大的膜周部VSD和漏斗部VSD的SC率较低,建议手术治疗。

Objective:To observe the spontaneous closure(SC)of ventricular septum defect(VSD)in congenital heart disease and to discuss the treatment time of VSD.Method:A total of 156 infants with single VSD were enrolled.All infants were divided into perimembranous VSD group(n=112),infundibular VSD group(n=20)and muscular VSD group(n=24),and then further divided into membranous tumour group(n=59)and non-membranous tumour group(n=53).All infants were divided into operation group(n=39)and SC group(n=88)according to whether SC or surgical closure occurred during the follow-up.The sizes of VSD between the two groups was compared at the end of follow-up.All infants were examined by echocardiography at the time of enrollment,1 month,6 th month and every 6 months thereafter.The incidence and the time of SC within 6 years were followed up until preschool age.Result:In 6 years of follow-up,the SC rate was the highest in muscular VSD group(87.5%),followed by perimembranous VSD group(57.14%)and infundibular VSD group(15.00%)(P<0.05).The occurrence time of SC in muscular VSD group was the earliest[(1.9±1.2)years old],followed by perimembranous VSD group[(2.3±1.5)years old]and infundibular VSD group[(2.7±0.05)years old](P<0.05).The SC rate in membranous tumour group was significantly higher than that in non-membranous tumour group(84.48%vs 28.30%,P<0.05).Thirty-nine infants underwent surgical closure treatment,including 7 cases of membranous tumor,19 cases of non-membranous tumor,12 cases of infundibular VSD and 1 case of muscle VSD.The size of VSD was(6.3±3.6)mm in operation group and(3.9±1.5)mm in SC group(P<0.05).Conclusion:More than half of the VSD with smaller defects can close spontaneously within 6 years,especially in those with muscular and membranous tumor VSD.The SC rates of perimembranous and infundibular VSD with large defect are low,so that surgical treatment is recommended.