摘要
目的探讨修补术联合三尖瓣成形术(TVP)治疗小儿嵴内型室间隔缺损(VSD)合并三尖瓣关闭不全的临床疗效.方法回顾性分析2016年1月至2017年10月在我院进行外科手术治疗的30例嵴内型VSD合并三尖瓣关闭不全患儿的临床资料.患儿全部采用吸入复合全麻及气管插管,左侧卧位,右侧腋下小切口行心内直视术.建立浅低温体外循环,主动脉根部灌注4℃冷晶体心肌停搏液,心包腔内置冰屑,在心肌阻断下手术.30例患儿均经右心房路径显露并连续缝合修补VSD,补片均采用涤纶布,合并三尖瓣关闭不全行TVP.结果平均体外循环时间为(52.25±14.50)min,主动脉阻断时间为(30.31±10.36)min,呼吸机支持时间为(10.45±3.58)h,ICU停留时间为(20.55±6.89)h,术中出血量为(58.85±11.22)ml,术后住院时间为(8.56±1.36)d;术后27例患儿未输血,其余3例患儿输血量不超过400 ml;院内未出现死亡病例,术后未出现肺部感染、肺不张、呼吸衰竭、残余漏、心律失常等并发症,但有5例患儿术后第1天有胸腔积液20~30 ml,术后3个月均消失;出院当天及术后3个月复查超声心动图,结果均显示无残余分流;出院当天复查X线胸片,结果显示心胸比从术前的0.56~0.60降到0.41~0.46,术前术后心胸比值差异具有统计学意义(P=0.032);术后3个月复查超声心动图显示,三尖瓣瓣环直径从25~30 mm缩小至20~24 mm,术后三尖瓣瓣环直径明显降低(P=0.021).术后随访10~24个月,所有患儿生长发育得到明显改善,无远期并发症发生.结论修补术联合TVP治疗小儿嵴内型VSD合并三尖瓣关闭不全的疗效良好,且安全可靠.
Objective To investigate the curative efect of ventricular septal defect(VSD)repair surgery combined with tricuspid valvuloplasty(TVP)for the treatment of intracristal ventricular septal defect(IVSD)associnated with tricuspid valve insufficiency in children.Methods The clinical data of 30 children with IVSD associnated with tricuspid valve insufficiency treated in our hospital from January 2016 to October 2017 were analyzed.All children were given tracheal intubation combined intravenous inhalational anesthesia then taken left latera lposition and a 3-8 cm incision was performed along right mid-axillary line.Shallow low temperature cardiopulmonary bypass were established.The aortic root was perfused with 4℃ cold crystal cardiac arrest fluid and the ice mud was embedded in the pericardial cavity.The operation was performed under myocardial block.Transatrial repair of intracristal ventricular septal defect was performed with continuous suture way and dacron was used as the reconstructive materials.TVP was performed to treat associated tricuspid valve insufficiency.Results The mean cardiopulmonary bypass time was(52.25±14.50)min and the mean aortic occlusion time was(30.31±10.36)min;the mean ventilator support time was(10.45+3.58)h,the mean ICU stay time was(20.55±6.89)h;the mean bleed quantity during operation was(58.85±11.22)ml and the mean length of hospital stay was(8.56±1.36)d.Afier surgery,27 cases did not receive blood transfusion and the rest 3 cases received less than 400 ml blood transfusion.No children died during and after operation and 5 cases had pleural effusion on the first day after operation,which was 20-30 ml but disappeared 3 months after operation;no other postoperative complications occured.such as pulmonary infection,atelectasis.respiratory failure,residual leakage and rrhythmia.Echocardiography was reexamined on the day of discharge and 3 months after operation,the results showed that there was no residual shunt.On the day of discharge,the chest radiograph showed that the cardiothoracic ratio decreased from 0.56-0.60 to 0.41-0.46,the difference of cardiothoracic ratio before and after operation was stitically significant(P=0.032).Echocardiography reexamination 3 months after operation showd that the diameter of tricuspid annulus decreased from 25-30 mm to 20-24 mm and the diameter of tricuspid annulus after operation was signifcantly lower than that of before operation(P=0.021).After 10-24 months of follow-up,the growth and development of all children were significantly improved and no long-term complications were found.Conclusion VSD repair surgery combined with TVP is safe and effective in the treatment of IVSD associated with tricuspid insufficiency in children.
作者
陈道虎
刘辉
葛广全
CHEN Dao-hu;LIU Hui;GE Guang-quan(Deparment of Cardiovascular Surgery,Second Hospital Afiliated to Hainan Medical College,Haikou 570311,China;Department of Anatomy,Hainan Medical Collge,Haikou 571199,China)
出处
《中国心血管病研究》
CAS
2020年第8期752-756,共5页
Chinese Journal of Cardiovascular Research
基金
国家自然科学基金项目(81560042)。
关键词
三尖瓣成形术
嵴内型室间隔缺损
三尖瓣关闭不全
Tricuspid valvuloplasty
Intracristal ventricular septal defect
Aortic valve insufficiency
