补片修补膜部室间隔缺损的一种手术方法

A New Method of Repairing Perimenbraneous Ventricular Septal Defects

目的 评价室间隔缺损 (VSD)修补术中 ,缝合其后下缘危险区时 ,直接从边缘进针与传统的超越法相比所具有的优点。 方法 选取 1984年 5月至 1996年 6月补片修补的VSD病人 ,按处理后下缘危险区的不同分为两组。比较其在产生完全性房室传导阻滞 ,完全性右束支传导阻滞 ,以及术后残余分流的发生率 ,并探讨它们在手术操作上的优缺点。 结果 采用新方法的病人无永久完全房室传导阻滞 ,其完全性右束支传导阻滞的发生率 ( 16 5 % )与传统方法完全性右束支传导阻滞的发生率 ( 3 1 9% )经统计学检验有明显的差异 (P =0 0 0 2 ,P <0 0 1)。新方法中术后残余分流 5例 ,全部位于VSD前上角。术后随访半年到 3年全部自行闭合。 结论 新方法处理膜部VSD未产生永久完全房室传导阻滞 ,CRBBB发生率低 ,无后下角残余分流 ,边缘显露确实 ,值得推荐。

Objective[WT5”BZ] To evaluate a new method of repairing the perimembraneous ventricular septal defect (VSD). [WT5”HZ]Methods[WT5”BZ] 354 patients with perimenbraneous VSD repaired with a patch were divided into two groups (group A and group B),according to the methods of repair.The stitches were placed on the edge of VSD in the area of the posterior inferior rim of VSD in the new method.But in the traditional method,the stitches were placed 5～7 mm away from the edge of the same area of the VSD.The traditional method was used in group A.The new method was used in group B.Complete heart block (CHB),complete right bundle branch block (CRBBB) and postoperative shunt were compared between the two groups. [WT5”HZ]Results[WT5”BZ] There was no shunt in the area of the posterior inferior rim of VSD in the two groups.The incidence of CRBBB in group B was statistically lower than that in group A.One patient in group A developed postoperative persistent complete heart block and died six months later.No patient developed postoperative persistent CHB in group B.There was 1 early postoperative death (1.1%) in group A and two early postoerative deaths (0.8%) in group B. [WT5”HZ]Conclusion The new method is safe and efficient and is worth being recommended.