单中心经右侧腋下途径外科封堵室间隔缺损近中期结果

摘要

目的 总结单中心室间隔缺损(VSD)经右侧腋下途径微创外科封堵近中期结果.方法 2014年1月至2017年12月在河南省人民医院儿童心脏中心经右腋下VSD封堵患儿624例,男304例,女320例,年龄(2.4±2.2)岁,体质量(12.3±10.2)kg;腋下3～5肋间长约2 cm切口,在食管超声引导下经右心房或右心室封堵VSD.结果 患儿VSD大小(4.2±0.9) mm,封堵器大小(5.2±1.2)mm.使用偏心封堵器28例,对称封堵器596例.手术时间(58.5±20.2)min,ICU停留(19.4±6.7)h.出血量(10.4 ±9.5)ml.全组无死亡病例,2例封堵器移位;无Ⅲ度房室传导阻滞、新增主动脉瓣反流、大出血二次开胸、严重感染等并发症.随访6～ 48个月,残余分流15例,10例随访期间愈合,5例随访中,无再次手术、主动脉瓣反流、Ⅲ度房室传导阻滞、封堵器脱落等并发症.结论 经腋下封堵VSD安全、有效,近中期结果满意,远期结果需要进一步随访.%Objective This retrospective,single-center study evaluated short-and mid-term results of minimally invasive surgery to occlude ventricular septal defects(VSDs) through right subaxillary approach.Methods The procedure was performed on 624 children,224 boys and 205 girls;aged(2.4 ± 2.2) years;mean weight(12.3 ± 10.2)kg between January 2014 to December 2017 at the Children' s Heart Center of Henan Province People' s Hospital.An approximately 2 cm right subaxillary incision was made between the third and fifth ribs.The right atrium or ventricle was punctured under the guidance of transencephalographic echocardiography(TEE).The VSD was occluded under TEE guidance.Results The mean size of VSDs was(4.2 ±0.9)mm,and the occluder measured(5.2 ± 1.2)mm.Asymmetrical occluders were used in 28 patieuts and symmetrical occluders in 596 patients.The operative time was(58.5 ± 20.2) minutes,and the time in the intensive care unit (ICU) was(19.4 ±6.7) h.Blood loss was(10.4 ±9.5) ml.There were no deaths among these patients.Occluder displacement occurred in two cases.The complications such as Ⅲ degree atrioventricular block,new aortic regurgitation,reoperation foi massive bleeding,and serious infection were not observed.All patients were followed up for 6-48 months.There were 15 cases of residual shunt after operation.Eight cases were self-closed during follow-up,and 5 cases were still followed up.No complications such as reoperation,aortic regurgitation,atrioventricular block or occluder abscission was observed during the follow-up period.Conclusion Occluding VSDs using the right subaxillary approach is safe and effective.Short-term and midterm results are satisfactory.Further follow-up is required regarding long-term results.