经左腋下小切口治疗小儿室间隔缺损合并动脉导管未闭8例临床观察
Journal of Chinese Practical Diagnosis and Therapy(2017)
Abstract
目的 探讨左腋下小切口途径镶嵌治疗小儿室间隔缺损合并动脉导管未闭的临床效果.方法 室间隔缺损合并动脉导管未闭患儿8例,采用左腋下小切口途径先行动脉导管结扎术,再于经食管超声心动图引导下经右心室表面穿刺行室间隔缺损经胸微创封堵术.术后4d行X线胸片观察有无胸腔积液,术后4d及出院后2周、3个月、6个月、1 a行心脏超声观察室间隔有无残余分流、有无瓣膜反流及封堵器脱落,行心电图检查观察有无心律失常.结果 8例均成功实施动脉导管结扎+经胸微创封堵术,手术均顺利;6例一次性封堵成功;1例膜周室间隔缺损选伞偏小,封堵后出现残余分流,术中更换大号封堵器后封堵成功;1例嵴内型室间隔缺损取5 mm对称伞封堵后出现主动脉瓣轻度反流,术中更换偏心伞封堵成功;术后4dX线胸片复查均未见明显胸腔积液;术后4d及出院后2周、3个月、6个月、1 a复查心脏超声示封堵器无脱落及异位,未见动脉导管残余分流,无新发三尖瓣反流及主动脉瓣反流,复查心电图无完全性房室传导阻滞发生.结论 经左腋下小切口治疗小儿室间隔缺损合并动脉导管未闭手术创伤小,效果满意.
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Key words
Ventricular septal defect with patent ductus arteriosus,left subaxillary incision,ligation of patent ductus arteriosus,minimal invasive closure procedure,children
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