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经微创左侧肋间切口对膜周部室间隔缺损患儿进行器械闭合。

Device closure via minimally invasive left intercostal incision in children with perimembranous ventricular septal defect.

机构信息

Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Xinquan Road No. 29, Fuzhou, 350001, Fujian Province, China.

Fujian Provincial Center for Cardiovascular Medicine, Fuzhou, 350001, Fujian Province, China.

出版信息

Sci Rep. 2024 Nov 2;14(1):26454. doi: 10.1038/s41598-024-77810-y.

DOI:10.1038/s41598-024-77810-y
PMID:39488552
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11531561/
Abstract

When treating perimembranous ventricular septal defect, median sternotomy leads to unsightly scar, right subaxillary thoracotomy requires cardiopulmonary bypass, and transcatheter device closure constrained by vascular condition. Using small left intercostal incision, we employed transthoracic device closure to get around these issues. During this study, right subaxillary thoracotomy was used for surgical repair in 117 patients (Surgical group), whereas small left intercostal incision was used for transthoracic device closure in 131 patients (Device group). Retrospective data collection and analysis were conducted. The success rate was comparable (117/117 vs. 130/131, P = 1.000). The device group experienced notably reduced operating time, mechanical ventilation duration, ICU stay, and postoperative hospital stay (All P < 0.001). Given that the device group's incision was much smaller than the surgical group's (1.1 ± 0.3 vs. 6.8 ± 1.6 cm, P < 0.001), blood transfusion or drainage tube was not needed. The device group observed a lower frequency of complications, with the exception of small residual shunt. It is feasible and safe to perform transthoracic device closure in children with perimembranous ventricular septal defects via small left intercostal incision. It can be a good minimally invasive substitute for surgical closure when utilized properly.

摘要

在治疗膜周部室间隔缺损时，正中开胸会导致难看的疤痕，右腋下小切口开胸需要体外循环，而经导管器械封堵则受到血管条件的限制。我们采用小左肋间切口，通过经胸器械封堵来解决这些问题。在这项研究中，117 例患者（手术组）采用右腋下小切口进行手术修复，而 131 例患者（器械组）采用小左肋间切口进行经胸器械封堵。回顾性收集和分析数据。成功率相当（117/117 与 130/131，P=1.000）。器械组的手术时间、机械通气时间、ICU 住院时间和术后住院时间明显缩短（均 P<0.001）。由于器械组的切口明显小于手术组（1.1±0.3 与 6.8±1.6 cm，P<0.001），因此无需输血或引流管。器械组并发症发生率较低，但仍有小残余分流。经小左肋间切口行经胸器械封堵治疗膜周部室间隔缺损是可行且安全的，在适当应用时可作为手术封堵的良好微创替代方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eac6/11531561/8ca0b73e8125/41598_2024_77810_Fig6_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eac6/11531561/db30c205719b/41598_2024_77810_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eac6/11531561/f3d3427a8a81/41598_2024_77810_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eac6/11531561/3ef49e2874cb/41598_2024_77810_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eac6/11531561/0cccabfa13e8/41598_2024_77810_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eac6/11531561/0c003e26c78a/41598_2024_77810_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eac6/11531561/8ca0b73e8125/41598_2024_77810_Fig6_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eac6/11531561/db30c205719b/41598_2024_77810_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eac6/11531561/f3d3427a8a81/41598_2024_77810_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eac6/11531561/3ef49e2874cb/41598_2024_77810_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eac6/11531561/0cccabfa13e8/41598_2024_77810_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eac6/11531561/0c003e26c78a/41598_2024_77810_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eac6/11531561/8ca0b73e8125/41598_2024_77810_Fig6_HTML.jpg

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本文引用的文献

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Expert Rev Cardiovasc Ther. 2023 May;21(5):337-345. doi: 10.1080/14779072.2023.2206566. Epub 2023 Apr 26.
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