单纯超声引导下经皮顺行法与逆行法治疗动脉导管未闭的回顾性队列研究

Treatment of patent ductus arteriosus via ultrasound-guided percutaneous antegrade or retrograde access:A retrospective cohort study

目的比较超声引导下经皮顺行法和逆行法治疗动脉导管未闭(patent ductus arteriosus,PDA)的手术疗效。方法回顾性分析2016年2月—2020年8月新疆心脑血管病医院心外科完成的经胸超声心动图(transthoracic echocardiography,TTE)引导下封堵PDA 166例患者的临床资料,其中男44例、女122例。根据手术入路将患者分为两组:顺行法组60例和逆行法组106例。比较两组手术时间、手术成功率、卧床时间、术后并发症发生率及手术安全性。结果两组术后即刻成功率100.0%。顺行法组卧床时间和住院时间较逆行法组短,但手术时间较逆行法组长。逆行法组并发症2例,其中1例术后12 h出现封堵器脱落,1例假性动脉瘤。两组均随访3~18个月,全组无死亡病例。结论TTE引导下经皮封堵PDA安全、有效;相对于逆行法,顺行法封堵PDA操作过程虽略显复杂、手术时间长,但适应证更广、下地活动早,可做为PDA封堵的首选方案。

Objective To compare the surgical results of ultrasound-guided percutaneous antegrade or retrograde therapy in the treatment of patent ductus arteriosus.Methods The clinical data of 166 patients(44 males and 122 females)who underwent transthoracic echocardiography guided closure of patent ductus arteriosus in Xinjiang Cardiovascular and Cerebrovascular Disease Hospital from February 2016 to August 2020 were retrospectively analyzed,and the patients were divided into two groups:an antegrade group(n=60)and a retrograde group(n=106).The operation time,success rate,bed rest time,postoperative complications and surgical safety were compared between the two groups.Results The immediate success rate of the two groups was 100.0%.Compared with the retrograde group,the antegrade group had shorter time of bed rest and hospital stay,but longer operation time.In the retrograde group,there were 2 patients of complications,including occlusive device falling off to pulmonary artery 12 hours after the operation in 1 patient,and false arterial tumor in 1 patient.Both groups were followed up for 3-18 months,and there was no death in the whole group.Conclusion It is safe and effective to block patent ductus arteriosus under the guidance of transthoracic echocardiography.Although the operation process of anterior occlusion of patent ductus arteriosus is slightly complex and the operation time is long,the indication is wide,and the bed rest time is short.Therefore it can be used as the first choice for patent ductus arteriosus occlusion.