经胸壁小切口偏心伞封堵术治疗小儿干下型室间隔缺损的临床效果

Clinical efficacy of transthoracic small-incision closure using non-equilateral occluder device for treatment of pediatric subpulmonary ventricular septal defect

目的观察经胸壁小切口偏心伞封堵术治疗小儿干下型室间隔缺损的临床效果。方法将50例干下型室间隔缺损患儿按治疗方法分为观察组和对照组,每组25例。观察组患儿采用经胸壁小切口偏心伞封堵术治疗,对照组患儿采用体外循环下室间隔缺损直视修补术治疗。比较两组患儿的手术时间、气管插管时间、输血率、术后并发率发生率及术后住院时间。结果观察组2例封堵不成功,中转常规开胸治疗。观察组手术时间、气管插管时间及术后住院时间均短于对照组,输血率及术后并发症发生率均低于对照组(均P<0.05)。术后随访6个月至2年,观察组患儿术后复查心脏彩超示封堵器左室侧伞盘长边朝向均正常,室间隔处封堵器均无室水平残余分流及封堵器移位,各心室腔及瓣膜均未见异常新生物回声,主动脉瓣均无明显返流。结论与传统的体外循环下室间隔缺损直视修补术相比,经胸壁小切口偏心伞封堵术治疗干下型室间隔缺损患儿的手术时间、气管插管时间及术后住院更短,输血率及并发症发生率更低,术后短期疗效显著,安全性较高。

Objective To observe the clinical efficacy of transthoracic small-incision closure using non-equilateral occluder device for the treatment of pediatric subpulmonary ventricular septal defect.Methods Fifty children with subpulmonary ventricular septal defect were divided into observation group and control group according to the treatment approach,with 25 cases in each group.Children in the observation group were treated with transthoracic small-incision closure using non-equilateral occluder device,while children in the control group were treated with direct repair of ventricular septal defect under cardiopulmonary bypass.Operation duration,endotracheal intubation time,blood transfusion rate,incidence rate of postoperative complications,and postoperative hospital stay were compared between the two groups.Results In the observation group,two cases failed in occlusion and were converted to conventional thoracotomy.Operation duration,endotracheal intubation time and postoperative hospital stay were shorter and blood transfusion rate and incidence rate of postoperative complications were lower in the observation group than in the control group(all P<0.05).After a postoperative follow-up of six months to two years,in the observation group,postoperative repeat color Doppler echocardiography showed normal orientation of the long side of left ventricular device disc of the occluder,no ventricular residual shunt or occluder displacement was observed in the occluder at ventricular septum,no abnormal neoplasm echo was found in any ventricular cavity or valve,and no obvious regurgitation occurred in aortic valve.Conclusion Compared with traditional direct repair of ventricular septal defect under cardiopulmonary bypass,transthoracic small-incision closure using non-equilateral occluder device achieves shorter operation duration,endotracheal intubation time and postoperative hospital stay as well as lower blood transfusion rate and incidence rate of complications in the treatment of children with subpulmonary ventricular septal defect,exhibiting remarkable postoperative short-term efficacy and higher safety.