本文選題：先天性心臟病 + 經(jīng)胸微創(chuàng)封堵術�。� 參考：《山東大學》2016年博士論文

【摘要】：研究背景近年來,先天性心臟病已成為導致新生兒死亡的最常見先天性畸形。最新統(tǒng)計數(shù)據(jù)顯示,在全球范圍內,每1000個活產嬰兒中就有8-12人罹患先天性心臟病。而在我國,1歲嬰兒中先天性心臟病發(fā)病率已逐年增加至1.11%,其中室間隔缺損、動脈導管未閉以及房間隔缺損是三種最常見的先心病。在一些患者中,常常存在兩種或兩種以上心臟畸形合并存在的情況�；颊卟⒋鎯煞N或兩種類型以上需要治療的心血管病變或畸形即為復合型先天性心臟病。復合型先天性心臟病并不少見,大約有50%手術治療的室間隔缺損病例有其他畸形合并存在,合并粗大或中等動脈導管未閉者占6%,其中25%有心功能不全;合并房間隔缺損者占17%；而在房間隔缺損患者中有10%合并肺動脈瓣狹窄,5%合并室間隔缺損,3%合并動脈導管未閉。室間隔缺損合并房間隔缺損、房間隔缺損合并動脈導管未閉,以及室間隔缺損合并動脈導管未閉通常不被歸類為嚴重的合并畸形,但一些嬰幼兒患者其肺部充血狀態(tài)常常較嚴重,應引起足夠重視,需早期糾正。全麻體外循環(huán)下開胸直視手術是治療復合型先天性心臟病的金標準。但是,這種治療方法本身存在不少缺陷,比如需心肺轉流、主動脈鉗夾阻斷、手術創(chuàng)傷大、恢復時間長等。在此背景下,經(jīng)皮介入技術逐漸發(fā)展起來。但是,這種介入治療方法本身也存在值得注意的缺陷,例如需長時間的心導管插入、需放射線的照射、增加房室傳導阻滯風險、損傷主動脈及心臟瓣膜、以及對患者血管通路條件要求較高。在過去的二十年中,隨著新專業(yè)技術知識的不斷發(fā)展,食道超聲引導下經(jīng)胸小切口封堵術迅速發(fā)展并已經(jīng)成為治療先天性心臟病的新選擇。先前的大量文獻報道中,已經(jīng)證實了這種新技術在治療單一先心病(尤其是單一室間隔缺損、動脈導管未閉和房間隔缺損)中的安全性及有效性。但是有關這種方法同期治療復合型先天性心臟病的研究較少,且具體手術方法及路徑尚無定論。研究目的通過本研究全面總結分析食道超聲引導下經(jīng)胸小切口封堵術治療復合型先天性心臟病的手術方法、手術的可行性以及其安全性,對幾種不同手術方案的優(yōu)缺點進行比較,為臨床推廣復合型先天性心臟病的食道超聲引導下經(jīng)胸小切口封堵治療提供借鑒。研究方法2010年2月至2016年7月,山東省立醫(yī)院心外科共有60例復合型先天性心臟病患者接受了食道超聲引導下經(jīng)胸小切口封堵術治療。其中男性25例,女性35例�；颊吣挲g4月至39歲(年齡中位數(shù)35.5月),其中1歲以內患者17例(28.3%),1-5歲患者34例(56.7%)。體重5.5-65kg(體重中位數(shù)13kg)。經(jīng)胸超聲心動圖檢查診斷,VSD合并ASD患者27例,VSD合并PDA患者16例,PDA合并ASD患者15例,VSD、ASD和PDA三種畸形同時并存患者2例。45例合并VSD的患者中膜周部室間隔缺損41例,干下型室間隔缺損4例；44例患者合并房間隔缺損,均為繼發(fā)孔型,2例為雙孔型房間隔缺損。33例合并PDA患者中,31例PDA為管狀,1例為窗型、1例為漏斗狀。房、室間隔分流信號為左向右分流。無中、重度心臟瓣膜反流,無心臟瓣膜器質性病變�；颊叩募{入標準及排除標準：1.納入標準：(1)超聲心動圖確診ASD、VSD、PDA,且邊緣良好,有封堵可能；(2)未合并需要同期體外循環(huán)下外科手術糾正的其他心血管畸形。2.排除標準：(1)超聲心動圖提示心臟瓣膜有中度以上的反流或脫垂；(2)合并有其他需體外循環(huán)下手術的先天性心臟病；(3)僅存在單一畸形；(4)已經(jīng)確診為艾森曼格綜合征,或經(jīng)胸超聲心動圖彩色多普勒血流顯像顯示心內缺損處血流呈右向左分流；(5)術前有尚未糾正的心力衰竭；(6)合并感染性心內膜炎；(7)有抗凝或抗血小板禁忌證患者。在全麻氣管插管下實施手術,術前經(jīng)食道超聲心動圖檢查,明確心臟畸形類型、大小,邊緣情況,并實時監(jiān)控整個封堵過程。根據(jù)經(jīng)食道超聲心動圖結果,選擇合適的封堵器及輸送系統(tǒng)備用。根據(jù)患者的不同合并畸形,將其分為4組：第1組為室間隔缺損合并房間隔缺損；第2組為室間隔缺損合并動脈導管未閉；第3組為房間隔缺損合并動脈導管未閉；第4組為同時合并室間隔缺損、房間隔缺損及動脈導管未閉三種畸形。根據(jù)患者心臟畸形的診斷、類型、部位及合并畸形組合情況、封堵難易程度選擇不同的手術切口及手術路徑,其中,第1組患者分別采用經(jīng)右胸-右房途徑、經(jīng)胸骨下段正中-右室、右房途徑、經(jīng)左胸-右室聯(lián)合經(jīng)皮介入途徑；第2組患者采用胸骨下段正中-右室、肺動脈途徑；第3組患者采用左胸-肺動脈聯(lián)合右胸-右房途徑；第4組采用胸骨正中-右室、右房、肺動脈途徑。術后1、3、6、12個月及此后每年一次隨訪。對封堵器的位置、穩(wěn)定性、是否存在殘余分流及封堵造成的新發(fā)心臟瓣膜并發(fā)癥進行評估。所得數(shù)據(jù)均采用SPSS19.0統(tǒng)計軟件進行統(tǒng)計學分析。數(shù)值變量資料以中位數(shù)或X±S表示。各項觀察指標間的兩兩比較方法采用配對單因素方差分析F檢驗、或卡方檢驗進行。顯著性水平取0.05,結果比較用P值,P0.05認為差異無統(tǒng)計學意義,P0.05認為差異具有統(tǒng)計學意義。結果本研究60例復合型先天性心臟病患者全部封堵成功(100%),共成功植入122枚封堵器,55例患者(91.7%)封堵器一次性植入成功,全部122次封堵器植入操作一次性植入成功率為95.9%。全部患者平均手術時間為77.9±28.9min(42-165分鐘)。VSD封堵時間約12.1±9.8min(4-55min)、ASD封堵時間7.0±4.0min(2-17min)、PDA封堵時間7.4±4.4min(2-17min)。所有患者于手術后24小時內拔除氣管內插管,呼吸輔助時間226.1±172.8(79-1020)分鐘；ICU觀察時間20.3±5.0(16-39)小時；術后住院5.4±1.5(3-8)天。隨訪期間經(jīng)胸超聲心動圖檢查未見ASD、PDA殘余分流。VSD封堵后殘余分流3例,均在隨訪3月至1年消失。術后新出現(xiàn)主動脈瓣反流3例,二尖瓣少量反流2例,三尖瓣反流2例。2例患者封堵后出現(xiàn)不完全性右束支傳導阻滯,術后第3月消失恢復正常心電圖。所有患者隨訪期間均未行再次手術。包括感染性心內膜炎、房室傳導阻滯、血栓栓塞、主動脈瓣及房室瓣損傷、死亡等在內的嚴重并發(fā)癥發(fā)生率為0。全部封堵器均無移位,且無周圍組織損傷。結論本研究證實了食道超聲引導下經(jīng)胸小切口封堵術治療復合型先天性心臟病的可行性,該方法未增加手術并發(fā)癥風險,未降低封堵成功率。食道超聲引導下經(jīng)胸小切口封堵術治療的關鍵在于不同手術路徑的靈活選擇、根據(jù)不同心臟畸形組合調整封堵順序、手術者的熟練操作、超聲醫(yī)師的精準評估、詳盡高效的備用方案的保駕護航。食道超聲引導下經(jīng)胸小切口封堵術對復合型先天性心臟病患者的治療相對其他治療方法有明顯優(yōu)勢：與傳統(tǒng)手術方式比較,該方法無需體外循環(huán),手術切口小,創(chuàng)傷小,手術時間短,呼吸機輔助時間短,術后恢復時間短,并發(fā)癥少；與介入方法比較,其無需X線暴露及造影劑、無體重及年齡限制、無血管條件限制、手術方案靈活、封堵方法簡單易掌握、一旦封堵失敗更能迅速改變手術方式確�；颊呱踩�。雖然存在以上優(yōu)勢,但該治療方法仍有不足：手術中仍需氣管插管全身麻醉、有時需2個手術切口且仍有病例需劈開胸骨增加了手術創(chuàng)傷。室間隔缺損合并房間隔缺損患者主要根據(jù)VSD的位置、形態(tài)、封堵的難易程度決定手術方案。合并的膜周部VSD直徑在2.0-7mm之間、或合并中間型mVSD、無需置入偏心型封堵器者采用右胸-右房單穿刺點手術方式。合并直徑2.0mm或7mm膜周部VSD、或心尖部VSD者推薦選擇經(jīng)胸骨正中切口,經(jīng)右心室封堵VSD、經(jīng)右心房封堵ASD。合并干下型VSD者選擇左胸-右室途徑封堵VSD,經(jīng)右胸-右房或經(jīng)皮封堵ASD。手術方案選擇的原則是創(chuàng)傷小優(yōu)先、不縱劈胸骨優(yōu)先、單穿刺點優(yōu)先。我們根據(jù)心內畸形糾正的難易程度及封堵并發(fā)癥風險的高低決定封堵順序。一般情況下首先對難度最高、風險最高的缺損進行封堵。一旦封堵失敗,盡早轉為體外循環(huán)直視下修補術。盡管本研究的結果令人鼓舞,但仍有存在病例樣本數(shù)量少、隨訪時間短、非隨機對照實驗等不足。
[Abstract]:In recent years, congenital heart disease (congenital heart disease) has become the most common congenital malformation causing death of the newborn. The latest statistics show that 8-12 of every 1000 live births have congenital heart disease worldwide. In our country, the incidence of congenital heart disease in 1 year old infants has increased to 1.11%, of which the ventricular septum is interventricular septum. Defects, patent ductus arteriosus, and atrial septal defect are three of the most common congenital heart diseases. In some patients, there are often two or more than two types of cardiac malformation. Patients with two or more than two types of cardiovascular disease or malformation are complex congenital heart disease. Complex congenital heart disease. It is not uncommon that about 50% cases of ventricular septal defect with surgical treatment are associated with other malformations, including 6% with large or medium patent ductus arteriosus, 25% of which have cardiac insufficiency, 17% with atrial septal defect, 10% with pulmonary stenosis, 5% with ventricular septal defect and 3% in combination with atrial septal defect. Ventricular septal defect, atrial septal defect combined with atrial septal defect, atrial septal defect with patent ductus arteriosus, ventricular septal defect combined with patent ductus arteriosus are often not classified as severe amalgamative malformation. However, some infants and young children are often more congested in their lungs and should be paid enough attention to early correction. General anesthesia extracorporeal circulation Open open chest surgery is the gold standard for the treatment of complex congenital heart disease. However, there are many defects in this method, such as cardiopulmonary bypass, aortic clamp blocking, surgical trauma, and long recovery time. In this context, percutaneous interventional techniques are gradually developed. However, this interventional therapy itself also exists. Noticeable defects, such as long cardiac catheterization, radiation of radiation, increased risk of atrioventricular block, injury of aorta and heart valves, and higher requirements for vascular access conditions in patients. In the past twenty years, with the continuous development of new professional knowledge, small incision closure under esophagus ultrasound guidance The rapid development of surgery has become a new choice for the treatment of congenital heart disease. The safety and effectiveness of this new technique in the treatment of single congenital heart disease (especially single ventricular septal defect, patent ductus arteriosus, and atrial septal defect) has been confirmed in a large number of previous reports. There are few studies on congenital heart disease, and the specific surgical methods and paths are not conclusive. The purpose of this study is to summarize and analyze the operative methods, the feasibility and safety of the small incision closure of the esophagus under the esophagus ultrasound guidance, and the advantages and disadvantages of several different surgical schemes. From February 2010 to July 2016, 60 patients with complex congenital heart disease in Shangdong Province-owned Hospital heart surgery received the treatment of small incision closure under the esophagus ultrasound guidance. Among them, 25 cases were male. 35 women aged from April to 39 years (median age 35.5 months), 17 (28.3%) in 1 years of age, 34 (56.7%) in 1-5 years of age, weight 5.5-65kg (median weight 13kg). Transthoracic echocardiography, 27 cases of VSD with ASD, 16 in VSD with PDA, 15 in PDA with ASD, VSD, ASD, and PDA of three deformities simultaneously There were 41 cases of peripheral ventricular septal defect in 2.45 patients with VSD, 4 cases of interdry ventricular septal defect, 44 cases with atrial septal defect, secondary pass, 2 case of double hole atrial septal defect in.33 and PDA, 31 cases of PDA as tube, 1 cases with window type and 1 cases of funnel like. Room and ventricular septal shunt signal were left to right Flow. No medium, severe heart valve reflux, no heart valve organic lesions. Inclusion criteria and exclusion criteria for patients: 1. inclusion criteria: (1) echocardiography confirmed ASD, VSD, PDA, well edge, blocking possibility; (2) other.2. exclusion criteria that need to be corrected by external cardiopulmonary bypass surgery at the same time: (1) super Echocardiography indicated that the heart valve had a moderate reflux or prolapse; (2) there were other congenital heart diseases that needed to be operated under extracorporeal circulation; (3) there was only a single deformity; (4) the diagnosis of Eisen Mange's syndrome, or the transthoracic echocardiography color Doppler flow imaging, showed that the blood flow in the heart defect was right to left shunt; 5) heart failure before operation; (6) combined infective endocarditis; (7) patients with anticoagulant or antiplatelet taboo. Operation under general anesthesia and tracheal intubation, preoperative transesophageal echocardiography, clear type, size, edge condition of cardiac malformation, and real-time monitoring of the whole process of occlusion. According to transesophageal echocardiography As a result, the appropriate occluder and delivery system were selected. According to the patients' different amalgamative malformation, they were divided into 4 groups: first groups were ventricular septal defect with atrial septal defect, the second group was ventricular septal defect with patent ductus arteriosus, the third was atrial septal defect combined with arterial conduit, and the fourth group was combined with ventricular septal defect at the same time. Three kinds of malformation of atrial septal defect and patent ductus arteriosus. According to the diagnosis, type, location and combination of deformity of the patients with cardiac malformation, different surgical incision and surgical path were selected. Among them, the first groups were treated by right chest to right atrium through the lower sternum right ventricle, right chamber via the left chest and right ventricle. The second groups of patients were treated with the middle and right ventricle of the lower segment of the sternum, the pulmonary artery pathway, the third groups were combined with the left thoracic and pulmonary artery and right chest right atrial pathway, the fourth group adopted the median sternum right ventricle, the right atrium, the pulmonary artery approach. 1,3,6,12 months after operation and subsequent follow-up. The new heart valve complications were evaluated by residual shunt and occlusion. The data were statistically analyzed by SPSS19.0 software. The data of the numerical variables were expressed as median or X S. The 22 comparison methods between the various observation indexes were performed by paired single factor analysis of variance F test, or chi square test. The results were 0.05, and the results were compared with the P value. P0.05 thought the difference was not statistically significant, and P0.05 thought the difference was statistically significant. Results all the 60 patients with complex congenital heart disease were successfully blocked (100%), 122 occluders were successfully implanted, 55 patients (91.7%) were implanted successfully and all 122 occluders were implanted. The average time of one time implantation was 95.9%., the average operation time was 77.9 + 28.9min (42-165 minutes),.VSD plugging time was 12.1 + 9.8min (4-55min), ASD blocking time was 7 + 4.0min (2-17min), and PDA occlusion time was 7.4 + 4.4min (2-17min). All patients were removed endotracheal intubation at 24 hours after operation, and the respiration assisted time was 226.1 + 172.8 (79-10). 20) minutes; ICU observation time was 20.3 + 5 hours (16-39) hours and postoperative hospitalization was 5.4 + 1.5 (3-8) days. There were no ASD and 3 remnants of residual shunt with PDA residual shunt during the follow-up period. All the patients were followed up for March to 1 years. 3 cases of aortic regurgitation, 2 cases of mitral regurgitation and three apex regurgitation in.2 patients after operation were followed up. Incomplete right bundle branch block was found after closure, and the normal electrocardiogram was recovered third months after the operation. All patients had no reoperation during the follow-up period. The incidence of severe complications, including infective endocarditis, atrioventricular block, thromboembolism, aortic valve and atrioventricular valve injury, and death, was 0.. Conclusion this study confirms the feasibility of treating complex congenital heart disease with small incision closure under esophagus ultrasound guidance. This method does not increase the risk of surgical complications and does not reduce the success rate of occlusion. The key to the treatment of small incision closure under the guidance of esophagus ultrasound guidance is the spirit of different surgical paths. The choice of live selection is to adjust the closure sequence according to the combination of different cardiac malformations, the skilled operation of the surgeon, the accurate evaluation of the ultrasonic physician, and the careful and effective reserve plan. The treatment of complex congenital heart disease by the esophagus ultrasound guidance is obviously superior to the other treatment methods for the patients with complex congenital heart disease: with the traditional hands. There was no need of external circulation, small incision, small wound, short operation time, short time of operation, short time of ventilator, short recovery time and less complications. Compared with the interventional method, no X-ray exposure and contrast agent, no weight and age limit, no blood tube condition, flexible operation plan, simple and easy mastery of blocking method, were not needed. The failure of denier blocking can quickly change the way of operation to ensure the safety of the patient. Although there are above advantages, there is still a shortage of the treatment method: the operation still needs general anesthesia for tracheal intubation, sometimes 2 surgical incisions are needed and the cases still need to split the sternum to increase the surgical trauma. The position, shape, and the difficulty of occlusion determine the operation plan. The VSD diameter of the peripheral membrane of the VSD is between 2.0-7mm, or the intermediate type mVSD, and the right chest and right atrial single puncture point operation is not needed for the eccentricity occluder. The VSD of the diameter 2.0mm or the 7mm membrane, or the apical VSD, is recommended by the median sternum incision and right through right Ventricular blockage of VSD, transcatheter closure of ASD. with right atrium and sub dry VSD, the choice of left chest right ventricular blocking VSD, the principle of selection by right chest right atrium or percutaneous blocking ASD. operation is small trauma priority, no longitudinal split sternum priority, single puncture point priority. We depend on the degree of intracardiac correction and the risk of blocking complications. In general, the most difficult and most risky defect is blocked. Once the closure fails, it is converted to the repair of the cardiopulmonary bypass as early as possible. Although the results of this study are encouraging, there are still fewer case samples, short follow-up time, and the inadequacy of the non machine control experiment.

【學位授予單位】：山東大學
【學位級別】：博士
【學位授予年份】：2016
【分類號】：R725.4

【相似文獻】

相關期刊論文 前10條

1 喬彬,朱萌,劉巖,吳莉莉,蔣怡燕,寧巖松,陳麗霞;實時三維超聲心動圖引導繼發(fā)孔房間隔缺損封堵術的可行性[J];實用醫(yī)藥雜志;2004年05期

2 孫娟;王志斌;;組織多普勒成像評價ASD封堵術后右心室長軸收縮功能的變化[J];浙江醫(yī)學;2007年08期

3 王峻松;王棉;王悅;;ASD封堵術前后右室功能變化的對比研究[J];中國實驗診斷學;2007年11期

4 侯傳舉;朱鮮陽;張端珍;王琦光;;彩色多普勒超聲心動圖在主動脈竇瘤破裂封堵術中的價值[J];中國介入心臟病學雜志;2011年04期

5 劉永生;王金鳳;于連慧;劉和平;劉德銘;;室缺封堵術后并晚發(fā)Ⅲ度房室傳導阻滯1例報告[J];吉林醫(yī)學;2007年08期

6 陳賽君;付淑萍;;經(jīng)食管超聲心動圖在先天性心臟病經(jīng)胸小切口封堵術中的應用[J];溫州醫(yī)學院學報;2012年03期

7 馬紅;楊麗娟;閆慧麗;豐麗英;邊敏;;超聲在先天性心臟病封堵術中的價值及術后心功能評價[J];中國醫(yī)藥導報;2006年36期

8 李偉;張玉順;杜亞娟;成革勝;;中老年繼發(fā)孔型房間隔缺損治療前后左房形態(tài)及功能的變化[J];心臟雜志;2012年02期

9 程永沖;祖正儒;;恩納、咪唑安定在小兒先天性心臟病封堵術中的應用[J];白求恩軍醫(yī)學院學報;2007年01期

10 邱罕凡;陳良萬;張貴燦;陳彩湄;陳道中;;微創(chuàng)封堵術治療繼發(fā)孔型房間隔缺損43例報告[J];中國微創(chuàng)外科雜志;2007年05期

相關會議論文 前10條

1 喬彬;朱萌;吳莉莉;蔣怡燕;王同建;張鋒泉;寧巖松;王春艷;;實時三維超聲心動圖在繼發(fā)孔房間隔缺損封堵術中的應用[A];第八屆華東六省一市胸心血管外科學術會議論文匯編[C];2005年

2 趙世華;王誠;蔣世良;徐仲英;黃連軍;凌堅;鄭宏;張戈軍;閆朝武;戴汝平;;中老年繼發(fā)孔型房間隔缺損形態(tài)學特點及其對封堵術的影響[A];中華醫(yī)學會第十三屆全國放射學大會論文匯編（下冊）[C];2006年

3 郭燕麗;宋治遠;張萍;李銳;;實時三維超聲心動圖在先天性心臟病封堵術中的臨床價值[A];第九屆全國超聲心動圖學術會議論文集[C];2007年

4 黃國英;馬曉靜;梁雪村;盛鋒;劉芳;吳琳;桂永浩;寧壽葆;;經(jīng)胸超聲心動圖在兒童膜周部室間隔缺損封堵術中的應用價值[A];2005年上海市生物醫(yī)學工程學會學術年會論文集[C];2005年

5 陳莉;宋治遠;郭燕麗;張志輝;;經(jīng)導管房間隔缺損封堵術對血清心房利鈉鈦、內皮素及心腔大小的影響[A];中華醫(yī)學會心血管病學分會第八次全國心血管病學術會議匯編[C];2006年

6 喬彬;朱萌;劉巖;吳莉莉;蔣怡燕;寧巖松;陳麗霞;;實時三維超聲心動圖獨立引導下繼發(fā)孔房間隔缺損封堵術[A];首屆中國先天性心臟病超聲診斷與介入治療暨手術演示學術會議論文集[C];2004年

7 黃先玫;朱衛(wèi)華;龔方戚;解春紅;汪偉;袁靜泊;;兒童繼發(fā)孔房間隔缺損封堵術療效與中期隨訪[A];2008年浙江省兒科學學術年會論文匯編[C];2008年

8 韓建一;;超聲心動圖指導先心病封堵術的應用現(xiàn)狀及進展[A];2004年浙江省超聲醫(yī)學學術年會論文匯編[C];2004年

9 孫勇;舒濤;廖崇先;楊謙;邱風;強海峰;林智;陳江華;蘇茂龍;;微創(chuàng)封堵術治療房間隔缺損107例[A];中華醫(yī)學會第七次全國胸心血管外科學術會議暨2007中華醫(yī)學會胸心血管外科青年醫(yī)師論壇論文集心血管外科分冊[C];2007年

10 王東;白明;;經(jīng)皮動脈導管封堵術中逆向抓捕技術的應用[A];第十三次全國心血管病學術會議論文集[C];2011年

相關重要報紙文章 前3條

1 鄭州人民醫(yī)院心臟外科主任 楊再珍 整理 賈慶東;先心封堵術也可彩超下完成[N];健康報;2013年

2 記者 房名名;我區(qū)先心病經(jīng)胸封堵術臨床應用國內領先[N];寧夏日報;2014年

3 記者 趙鵬;西北首例左心耳封堵術順利完成[N];咸陽日報;2014年

相關博士學位論文 前2條

1 王建銘;成人膜周部室間隔缺損封堵術的安全性及有效性研究[D];第四軍醫(yī)大學;2016年

2 賈煈婷;食道超聲引導下經(jīng)胸小切口封堵術治療復合型先天性心臟病的臨床研究[D];山東大學;2016年

相關碩士學位論文 前10條

1 喬俊杰;經(jīng)胸微創(chuàng)封堵術與傳統(tǒng)外科手術治療大型繼發(fā)孔房間隔缺損的對比研究[D];鄭州大學;2015年

2 陳榮榮;經(jīng)靜脈與經(jīng)胸導管封堵術治療室間隔缺損的配比研究[D];福建醫(yī)科大學;2015年

3 鄒國穩(wěn);經(jīng)食管超聲引導外科封堵術治療漏斗部室間隔缺損的有效性回顧性研宄[D];南昌大學醫(yī)學院;2015年

4 段艷;二維斑點追蹤技術評價房間隔缺損患者封堵術前、后左室收縮功能的變化[D];第四軍醫(yī)大學;2014年

5 貝玉瓊;二維及實時三維超聲心動圖評價房間隔缺損封堵術后右室容積的臨床研究[D];廣西醫(yī)科大學;2016年

6 馬文潔;偏頭痛合并卵圓孔未閉患者封堵術后的療效研究[D];延安大學;2016年

7 莫劍梅;先天性心臟病經(jīng)皮導管封堵術后心電及心室重構變化的研究[D];廣西醫(yī)科大學;2006年

8 何群燕;實時三維超聲心動圖定量評價成人房間隔缺損封堵術前后右心室舒張功能變化的研究[D];廣西醫(yī)科大學;2015年

9 張毅;經(jīng)胸壁微創(chuàng)封堵術與介入封堵術在治療膜周部室間隔缺損上的對比研究[D];福建醫(yī)科大學;2013年

10 石晶;超聲心動圖和組織多普勒對房室間隔缺損封堵術療效觀察的研究[D];第四軍醫(yī)大學;2005年

，

本文編號：1795999