分期手术治疗婴幼儿肌部多发性室间隔缺损效果分析

Stagedsurgical treatment of multiple ventricular septal defects with severe pulmonary hypertension

目的:总结探讨婴幼儿肌部多发性室间隔缺损(VSD)行分期手术的效果。方法:回顾性分析2010年1月至2018年12月北京安贞医院婴幼儿期多发性VSD患儿29例行分期手术的的临床资料,男性18,女性11例,中位年龄5(3,6)个月,中位体质量5.7(5.2,6.5)kg。均先行肺动脉环缩术(PAB),PAB术后平均(28.47±6.75)个月时后全部行根治手术,其中3例肌部缺损行直视封堵。同期行一期根治30例,男性14,女性16例,中位年龄12(6,32.25)个月,中位体质量9.15(6.275,12.725)kg。对比分析两组患儿的临床数据。结果:分期治疗组患儿无住院死亡,一期根治组患儿2例术后并发低心排综合征,其中住院死亡1例。分期手术组患儿行PAB手术时的年龄、体质量均小于一期根治组,主肺动脉/主动脉根部直径比值均大于一期根治组,差异有统计学意义。两组患儿行根治手术时术中术后及随访的临床数据差异无统计学意义。全组患儿根治手术后随访28(7,98)个月,残余分流7例(VSD直径<2 mm)。结论:对于婴幼儿期多发性VSD,应考虑先行PAB,后再行双心室根治性手术;对于肌部多发VSD可采用直视杂交封堵。

Objective:To summarize and discuss the surgical treatment strategy and effection in children with multiple ventricular septal defect(VSD).Methods:Retrospectively analyzedtheclinical data of 29 children with multiple VSD in Beijing anzhen hospital from January 2010 to December 2018,treated by staged surgery,including 18 males and 11 females,the averageaged 5(3,6)months,and the average weight 5.7(5.2,6.5)kg.PAB was performed at the initial stage,and All the childrenunderwent radical surgeryafter 1137(28.47±6.75)months,among which 3 patients underwent direct vision blocking operation.And in the same period,There were 30 cases were treated by primary radical therapy,including 16 cases of 14 males and 16 females,with an average age of 12(6,32.25)months.The average body weight was 9.150(6.275,12.725)kg.The clinical data of preoperative,middle and postoperative follow-up were compared and analyzed.Results:There were no hospitalized deaths in the staging group,and 2 patients in the primary radical treatment group were complicated with low cardiac drainage syndrome after surgery,among which 1 patient died in hospital(left ventricular apical incision).The age and the weight of children in the staging group who underwent PAB surgery were all smaller than those in the primary radical group,the ratio of diameter of the main pulmonary artery/aor-tic root and were all larger than those in the primary radical group,and the difference was significant.Postoperative ventricular residual shunt(diameter<2 mm)occurred in 7 cases,including 3 cases in radical group and 4 cases in staging group.During the follow-up period of 28(7-98 months)after radical surgery.Conclusions:For infants with multiple VSD,PAB should be considered at the time of,followed by radical biventricular sur-gery;Hybridization can be used to block multiple compartment defects in muscle.