膜周部室间隔缺损介入封堵和外科修补后常见并发症的对比分析
Comparison of common complications of transcatheter and surgical closure of perimembranous ventricular septal defects
Received date: 2021-07-23
Online published: 2022-05-13
目的 分析介入封堵和外科修补治疗儿童膜周型室间隔缺损（pmVSD）后常见并发症情况,为临床上个体化优选治疗方案提供依据。方法 回顾性分析2014年6月至2020年4月期间住院治疗的pmVSD患儿的临床资料。根据最终采取的手术方式分为介入组和修补组,分析比较两组患儿术后常见并发症情况及随访资料。结果 最终入选499例患儿。介入组284例,男130例、女154例,中位年龄42.0（33.0~56.0）月;修补组215例,男100例、女115例,中位年龄40.0（30.0~60.0）月。两组之间术后1周内残余分流,主动脉瓣、二尖瓣和三尖瓣反流发生率的差异无统计学意义（P>0.05）。修补组术后1周内新发心律失常、完全性及不完全性右束支传导阻滞的发生率均高于介入组,差异有统计学意义（P<0.05）。至随访终点时间,两组患儿的残余分流、瓣膜反流及传导阻滞情况均明显改善,两组间差异均无统计学意义（P>0.05）。结论 介入封堵和外科修补治疗儿童膜周部室间隔缺损同样有效,且介入治疗创伤小、并发症少,是一个不错的选择。
赵小佩 , 张永为 , 肖婷婷 . 膜周部室间隔缺损介入封堵和外科修补后常见并发症的对比分析[J]. 临床儿科杂志, 2022 , 40(5) : 370 -375 . DOI: 10.12372/jcp.2022.21e1088
Objective To analyze the common complications of the transcatheter and the surgical approach to correct perimembranous ventricular septal defect (pmVSD) in children, and to provide a basis for clinically individualized optimal treatment plan. Methods The clinical data of hospitalized children diagnosed with pmVSD between June 2014 and April 2020 were retrospectively analyzed. Based on the final surgical approach, 284 patients were divided into interventional and repair groups. Common postoperative complications and follow-up data between these two groups were analyzed. Results Of the 499 children finally enrolled. 284 cases were in the interventional group, 130 males and 154 females, with a median age of 42.0 (33.0-56.0) months, and 215 cases were in the repair group, 100 males and 115 females, with a median age of 40.0 (30.0-60.0) months. There was no statistically significant difference in the incidence of residual shunt, aortic valve, mitral valve, and tricuspid regurgitation within 1 week after surgery between the two groups (P>0.05). The incidence of new arrhythmias and complete and incomplete right bundle branch block within 1 week postoperatively was higher in the repair group than in the intervention group, and the difference was statistically significant (P<0.05). At the end of follow-up, residual shunt, valve regurgitation and conduction block were significantly improved in both groups, with no statistically significant differences between the two groups (P>0.05). Conclusion Interventional occlusion and surgical repair are equally effective in treating perimembranous ventricular septal defects in children, and interventional treatment is less invasive and has fewer complications.
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