小腰大边和对称型封堵器治疗小儿膜部瘤型室间隔缺损的对比研究

发布时间：2018-07-16 16:21

【摘要】：目的分析比较不同类型的国产封堵器封堵小儿膜部瘤型室间隔缺损(pm VSD)的可行性、安全性和疗效,为小儿膜部瘤型室间隔缺损寻找最佳治疗方案。方法选择2013年3月-2015年3月在我院查体听诊心脏杂音且经胸超声心动图(transthoracic echocardiography,TTE)筛查并经介入造影确诊膜部瘤型室间隔缺损(pm VSD)的68例患儿作为研究对象。按照手术时选用封堵器的类型随机分为两组:对称型封堵器进行封堵30例(对称组);小腰大边封堵器进行封堵38例(小腰大边组)。术前行三大常规、肝肾功心肌酶等检验、心脏彩超、心电图检查,术后24小时,1月,3月,6月,12月入院复查心脏彩超、心电图、心脏正侧位片等检查,比较两组术前资料(包括年龄、体重、VSD直径、术前心胸比值、手术时间)差异,比较两组术后封堵的效果、术后住院时间、成功率和并发症(主要包括残余分流、瓣膜返流、心律失常)发生率的差异。结果术前资料,其中男32例,女36例;年龄2.6-12岁(5±2.2岁),体重11 43Kg(15.4±5.1 Kg),身高90 146cm(101±10.2 cm),对比两组术前资料,两组患儿的年龄、体重、VSD直径及心胸比值、手术时间方面差异不显著(P0.05)。68例患儿术前存在心律失常6例,对称组、小腰大边组各3例(包括CRBBB2例、IRBBB2例、LAFB1例、I°AVB1例)。68例患儿中封堵成功60例,封堵失败或放弃封堵8例,其中,小腰大边组(36/38)封堵成功率高于对称组(24/30)。术后心脏大小、LVDd均较术前减小,但无统计学差异(P0.05),分别对比不同时间点两组的心脏大小及心脏收缩功能的各项指标,均无显著性差异(P0.05)。术后早期资料分析,两组均无死亡病例,无完全性房室传导阻滞、封堵器脱落或移位、心内膜炎等严重并发症发生。术后早期,对称组新发心律失常4例(CRBBB 1例、IRBBB 2例,CLBBB 1例),术后瓣膜返流6例(少量三尖瓣返流5例,主动脉瓣返流由微量加重到少量反流1例),残余分流2例,均为少量分流;小腰大边组新发心律失常2例(CRBBB 1例、IRBBB1例),瓣膜返流3例(少量三尖瓣返流2例,主动脉瓣返流由微量加重到少量反流1例),无残余分流。60例患儿中,共完成随访57例,3例失访。所有随访患儿均无死亡病例,无封堵器脱落、封堵器移位、无重度PAH发生。长期随访数据显示,小腰大边组无残余分流,新发三尖瓣返流1例,新发IRBBB 1例;对称组仍存在残余分流2例,新发三尖瓣返流2例,均为少量返流,CRBBB 1例;2组比较,主动脉瓣返流较术后早期无加重及新发病例。结论小腰大边封堵器治疗pm VSD成功率高,并发症少,疗效可靠,与对称封堵器相比有明显的优势。但本组数据病例数目较少,随访时间短,部分资料随访不够全面,因此,远期疗效仍需要更多、更系统的随访资料进一步观察。
[Abstract]:Objective to compare the feasibility, safety and efficacy of different types of domestic occluder in the treatment of membranous neoplastic ventricular septal defect (pm VSD) in children. Methods Sixty-eight children with membranous neoplastic ventricular septal defect (pm VSD) were selected from our hospital from March 2013 to March 2015, who were screened by transthoracic echocardiography and confirmed by interventional angiography. According to the type of occluder used in the operation, they were randomly divided into two groups: 30 cases with symmetrical occluder (symmetrical group) and 38 cases with small lumbar side occluder (small lumbar side group). Before operation, three major routine examinations were performed, including liver and kidney function and myocardial enzyme test, echocardiography, electrocardiogram, 24 hours, 1 month, 3 months, 6 months and 12 months after operation, and the examination of echocardiography, electrocardiogram, positive and lateral radiography of the heart, etc. The preoperative data (including age, body weight, VSD diameter, preoperative cardiothoracic ratio, operative time) were compared between the two groups. The effect of closure, postoperative hospitalization time, success rate and complications (including residual shunt, valvular regurgitation) were compared between the two groups. The difference in the incidence of arrhythmias. Results preoperative data, including 32 males and 36 females, aged from 2.6 to 12 years (5 卤2.2 years), weight 11: 43Kg (15.4 卤5.1kg), height 90 146cm (101 卤10. 2 cm),) were compared between the two groups. The age, body weight, diameter of VSD and cardiothoracic ratio were compared between the two groups. There was no significant difference in operative time (P0.05) .68 cases had arrhythmia before operation, 6 cases had arrhythmia before operation, 3 cases in symmetrical group and 3 cases in small waist big side group (including CRBBB2 case, IRBBB2 case, LAFB1 case, I 掳AVB1 case). Among 68 cases, 60 cases were successfully occluded, 8 cases were failed or abandoned. The success rate of occlusion in the small waist and large side group (36 / 38) was higher than that in the symmetrical group (24 / 30). Postoperative heart size and LVDd decreased compared with the preoperative, but there was no statistical difference (P0.05), the heart size and cardiac systolic function of the two groups were compared at different time points, there was no significant difference (P0.05). There were no death cases, no complete atrioventricular block, occluder loss or displacement, endocarditis and other serious complications in both groups. In the early stage of operation, 4 cases of new arrhythmia (1 case of CRBBB 1 case of IRBBB 2 cases of CLBBB), 6 cases of valve regurgitation (5 cases of tricuspid regurgitation, 1 case of aortic regurgitation), 2 cases of residual shunt. There were 2 cases of new arrhythmia (CRBBB 1 case of IRBBB1), 3 cases of valvular regurgitation (2 cases of minor tricuspid regurgitation, 1 case of aortic regurgitation from slight exacerbation to 1 case of aortic regurgitation). A total of 57 cases were followed-up and 3 cases lost. All the children were followed up with no death, no occluder loss, occluder displacement and no severe PAH. Long-term follow-up data showed that there were no residual shunt, 1 new tricuspid regurgitation and 1 new IRBBB in the small lumbar side group, and 2 cases in the symmetrical group and 2 cases in the new tricuspid regurgitation group. Aortic valve regurgitation was no more severe and new than that of early postoperative patients. Conclusion small lumbar occluder with large side occluder has high success rate, few complications and reliable therapeutic effect. It has obvious advantages over symmetrical occluder. However, the number of data in this group is relatively small, the follow-up time is short, and some of the follow-up data are not comprehensive enough. Therefore, the long-term effect still needs more and more systematic follow-up data to be further observed.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R725.4

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