超声心动图引导经胸小切口室间隔缺损封堵术临床分析
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摘要
目的探讨超声心动图引导经胸小切口室间隔缺损封堵术的临床应用价值、安全性以及治疗效果。方法整群选取该院在2014年5月—2016年12月收治的22例进行超声心动图引导经胸小切口室间隔缺损(VSD)封堵术的患者作为研究对象。对封堵术后1周、1个月、3个月、半年以及1年的封堵效果进行随访和观察。结果所有的22例患者中有20例封堵成功,占90.9%。患者的平均年龄为(8.3±10.6)岁,患者的平均体重为(22.6±17.4)kg,在手术前需要使用胸经超声心动图(TTE)对缺损的大小、类型以及形态进行观察,这样才能对封堵器的型号进行初步确定,患者的VSD平均为(4.7±1.1)mm,封堵器平均为(7.1±1.2)mm;在手术中使用经食管超声心动图(TEE)引导封堵器进行正确的放置,VSD平均为(4.8±1.1)mm,封堵器平均为(7.8±1.5)mm。术前TTE测量VSD数据组与术中经TEE测量数据组比较;术中实际确定封堵器型号与术前初步选择封堵器型号比较,差异无统计学意义(P>0.05)。在1年内对患者进行定期随访,所有患者的封堵回声清晰,并且位置没有发生变化,没有出现明显瓣膜反流和室水平室残余分流。结论使用超声心动图引导经胸小切口室间隔缺损封堵术,术前的病例认真、细致筛选、术中封堵以及术后疗效均能够得到有效的保证,并且具有一定的安全性。
Objective To discuss the echocardiography guided small chest incision occlusion of ventricular septal defect clinical value, safety and therapeutic effect. Methods In our hospital in May 2014 to December 2016 22 cases of echocardiography guided small chest incision of ventricular septal defect(VSD) occlusion patients as the research the object for 1weeks. After transcatheter closure, 1 months, 3 months of follow-up observation and a half years plugging effect. Results All the 22 patients in 20 cases of closure, accounting for the average age of 90.9%. patients was(8.3±10.6)years old, average patient Weight(22.6±17.4)kg, before the operation to map by echocardiography using chest(TTE) on the size of the defect, type and morphology were observed, so as to determine preliminarily occluder models, with average VSD(4.7±1.1)mm,average occluder(7.7±1.2)mm; the use of transesophageal echocardiography in surgery(TEE) to guide the device correctly placed, the VSD average(4.8±1.1)mm, average occluder(7.8±1.5)mm. preoperative TTE and intraoperative VSD measurement data set by TEE Comparison of measurement data in actual operation group; determine the occluder with preoperative preliminary selected occluder comparison, no statistically significant difference(P>0.05). The patients were followed up regularly, within a year, all patients with clear and blocking echo, position did not change significantly and the level of ventricular valve regurgitation of residual shunt did not appear. Conclusion Echocardiography guided small chest incision occlusion of ventricular septal defect using ultrasound, preoperative cases seriously, careful screening, intraoperative and postoperative curative effect of plugging can be effectively ensured, and has a certain safety.
Objective To discuss the echocardiography guided small chest incision occlusion of ventricular septal defect clinical value, safety and therapeutic effect. Methods In our hospital in May 2014 to December 2016 22 cases of echocardiography guided small chest incision of ventricular septal defect(VSD) occlusion patients as the research the object for 1weeks. After transcatheter closure, 1 months, 3 months of follow-up observation and a half years plugging effect. Results All the 22 patients in 20 cases of closure, accounting for the average age of 90.9%. patients was(8.3±10.6)years old, average patient Weight(22.6±17.4)kg, before the operation to map by echocardiography using chest(TTE) on the size of the defect, type and morphology were observed, so as to determine preliminarily occluder models, with average VSD(4.7±1.1)mm,average occluder(7.7±1.2)mm; the use of transesophageal echocardiography in surgery(TEE) to guide the device correctly placed, the VSD average(4.8±1.1)mm, average occluder(7.8±1.5)mm. preoperative TTE and intraoperative VSD measurement data set by TEE Comparison of measurement data in actual operation group; determine the occluder with preoperative preliminary selected occluder comparison, no statistically significant difference(P>0.05). The patients were followed up regularly, within a year, all patients with clear and blocking echo, position did not change significantly and the level of ventricular valve regurgitation of residual shunt did not appear. Conclusion Echocardiography guided small chest incision occlusion of ventricular septal defect using ultrasound, preoperative cases seriously, careful screening, intraoperative and postoperative curative effect of plugging can be effectively ensured, and has a certain safety.
引文
[1]何慧灵.经胸小切口室间隔缺损封堵术中经食管超声心动图的应用实效性评价[J].浙江创伤外科,2016,21(4):716-718.
[2]张学勤,邢泉生,武钦.经胸封堵与右腋下小切口直视修补婴幼儿膜周部室间隔缺损的结果对比[J].中华胸心血管外科杂志,2015,31(9):527-532.
[3]梁飞.经胸微创封堵术在婴儿膜周部室间隔缺损患者中的治疗经验:中期随访结果[J].中国循环杂志,2015(s1):105.
[4]韦舒静,叶宁,郑晓宇,等.超声心动图在小切口封堵术治疗先天性心脏病中的应用研究[J].广西医学,2015(6):828-830.
[5]郭能瑞,孙鹏飞,张森,等.闭式体外循环辅助下经右胸前外侧小切口微创心脏外科手术的临床总结[J].中国循环杂志,2016,31(9):888-891.
[6]邢泉生.如何理性看待先天性心脏病经胸微创封堵技术的迅速发展[J].国际心血管病杂志,2016,43(3):129-132.
[7]谢立,黄灿,吴斯杰,等.食道超声心动图引导下经胸小切口行肺动脉瓣球囊扩张术治疗婴幼儿肺动脉瓣狭窄[J].中南大学学报:医学版,2016,41(7):691-695.
[8]马伦超,陆国梁,杨超,等.左胸骨旁小切口封堵分流方向偏向流出道的室间隔缺损15例[J].中国胸心血管外科临床杂志,2016(3):304-306.
[2]张学勤,邢泉生,武钦.经胸封堵与右腋下小切口直视修补婴幼儿膜周部室间隔缺损的结果对比[J].中华胸心血管外科杂志,2015,31(9):527-532.
[3]梁飞.经胸微创封堵术在婴儿膜周部室间隔缺损患者中的治疗经验:中期随访结果[J].中国循环杂志,2015(s1):105.
[4]韦舒静,叶宁,郑晓宇,等.超声心动图在小切口封堵术治疗先天性心脏病中的应用研究[J].广西医学,2015(6):828-830.
[5]郭能瑞,孙鹏飞,张森,等.闭式体外循环辅助下经右胸前外侧小切口微创心脏外科手术的临床总结[J].中国循环杂志,2016,31(9):888-891.
[6]邢泉生.如何理性看待先天性心脏病经胸微创封堵技术的迅速发展[J].国际心血管病杂志,2016,43(3):129-132.
[7]谢立,黄灿,吴斯杰,等.食道超声心动图引导下经胸小切口行肺动脉瓣球囊扩张术治疗婴幼儿肺动脉瓣狭窄[J].中南大学学报:医学版,2016,41(7):691-695.
[8]马伦超,陆国梁,杨超,等.左胸骨旁小切口封堵分流方向偏向流出道的室间隔缺损15例[J].中国胸心血管外科临床杂志,2016(3):304-306.