体外循环下先心病矫治术在封堵失败患者中应用的临床经验和近期随访结果

Clinical experience and short-term follow-up results of ventricular septal defect correction under cardiopulmonary bypass in patients with failed transthoracic minimally invasive device closure

目的总结应用食道超声引导下腋下途径微创封堵治疗室间隔缺损失败后改行体外循环下修补术的临床经验和近期随访结果。方法回顾性分析河南省人民医院2014年1月至2019年12月采用食道超声引导下腋下途径微创封堵治疗室间隔缺损失败患者共62例,其中男27例,女35例,年龄0.7~8.3岁,平均(2.8±2.1)岁,体重7.2~32.0 kg,平均(12.2±7.1)kg。在右侧腋中线第四肋间做约2~3 cm的切口行外科封堵失败后于原切口扩大至5~6 cm后改行体外循环下修补术。术后定期随访,复查经胸超声心动图,心电图和X线胸片。结果62例封堵失败患者,封堵尝试时间(21±5.1)min,体外循环准备时间(10.2±2.2)min,体外循环时间(82±6.4)min,心肌阻断时间(34±6.7)min,3例(4.8%)术后发生残余分流,其中2例分别于术后随访3个月时自行闭合,另1例随访6个月仍存残分。定期随访1.0~17.8(7.3±4.0)个月中无完全性房室传导阻滞及其他并发症。结论体外循环下修补手术作为微创封堵失败的先心患者的替代治疗手段,可以在原微创封堵切口上施行手术,是安全、可靠、有效的治疗方法,避免了二次手术的创伤,是外科医生进行微创封堵的优势所在。

【Objective】To summarize the clinical experience and recent follow-up results of ventricular septal defect(VSD)under the cardiopulmonary bypass(CPB)in patients with failed transesophageal ultrasound-guided transthoracic minimally invasive closure(TMIC).【Methods】A retrospective analysis of 62 patients(27 males and 35 females),aged 0.7–8.3(2.8±2.1)years old and weighted 7.2–32.0(12.2±7.1)kg,who failed to treat with transthoracic minimally invasive closure of ventricular septal defect under the guidance of esophageal ultrasound in Henan Provincial People's Hospital from January 2014 to December 2019.Making an incision of about 2–3 cm in the fourth intercostal space of the right midaxillary line,the original incision was enlarged to 5–6 cm and then the operation was changed to under cardiopulmonary bypass after the TMIC fails.The patients were followed up regularly after operation,and the transthoracic echocardiography,electrocardiogram and chest X-ray were reviewed.【Results】Sixty-two patients with failed TMIC,the time of TMIC attempt was 21±5.1 min,the preparation time of cardiopulmonary bypass was 10.2±2.2 min,the cardiopulmonary bypass time was 82±6.4 min,and the myocardial blocking time was 34±6.7 min.Three patients(4.8%)developed residual shunt after operation,and 2 of them closed automatically after 3 months of follow-up.There was no complete atrioventricular block and other complications during 1.0-17.8(7.3±4.0)months of follow-up.【Conclusion】Repair under cardiopulmonary bypass(CPB)is a safe,reliable and effective treatment method,which can be performed on the TMIC.