【摘要】：目的研究食管超聲心動圖引導(dǎo)技術(shù)(TEE)在房間隔缺損(ASD)和室間隔缺損(VSD)介入封堵術(shù)中的應(yīng)用價值,探討該技術(shù)的可行性材料與方法回顧性分析鄭州大學(xué)人民醫(yī)院(河南省人民醫(yī)院)2013年11月至2016年2月在食管超聲心動圖引導(dǎo)下行房、室間隔缺損介入封堵術(shù)患者的臨床資料,總結(jié)食管超聲心動圖引導(dǎo)下行房、室間隔缺損介入封堵術(shù)的操作技巧與要點。研究:1.食管超聲心動圖引導(dǎo)下經(jīng)股靜脈途徑行房間隔缺損介入封堵術(shù)的可行性;2.食管超聲心動圖引導(dǎo)下經(jīng)頸內(nèi)靜脈途徑行房間隔缺損介入封堵術(shù)的可行性;3.食管超聲心動圖引導(dǎo)下經(jīng)股動脈途徑逆行插管行室間隔缺損介入封堵術(shù)的可行性;與同期連續(xù)放射線下行常規(guī)房、室間隔缺損介入封堵術(shù)患者分別從手術(shù)時間、成功率、應(yīng)用放射線和對比劑多少、并發(fā)癥、臥床時間、住院時間及術(shù)后短期隨訪結(jié)果等進行對比研究,以確定食管超聲心動圖引導(dǎo)技術(shù)行房、室間隔缺損介入封堵術(shù)在臨床中的應(yīng)用價值。1.食管超聲心動圖引導(dǎo)下經(jīng)股靜脈途徑行房間隔缺損介入封堵術(shù)21例患者全部成功,術(shù)中未應(yīng)用放射線,與同期連續(xù)73例放射線下常規(guī)房間隔缺損介入封堵術(shù)患者比較,在成功率、手術(shù)操作時間、住院時間、及術(shù)后并發(fā)癥方面無統(tǒng)計學(xué)差異(p0.05)。2.食管超聲心動圖引導(dǎo)下經(jīng)頸內(nèi)靜脈途徑行房間隔缺損介入封堵術(shù)25例,24例成功,1例雙孔型房間隔缺損患兒,封堵大孔后,小孔未完全覆蓋殘余5mm過隔血流,術(shù)中轉(zhuǎn)為外科側(cè)開胸修補手術(shù)成功。25例患者術(shù)中均未應(yīng)用放射線,與連續(xù)73例放射線下常規(guī)房間隔缺損介入封堵術(shù)患者相比,基本資料、住院時間均無統(tǒng)計學(xué)差異(p0.05),但在手術(shù)操作時間及臥床時間較對照組明顯縮短,且差異有統(tǒng)計學(xué)意義(p㩳0.05)。3.食管超聲心動圖引導(dǎo)下經(jīng)股動脈逆行插管行室間隔缺損介入封堵術(shù)患者14例,手術(shù)全部成功,均未應(yīng)用放射線和造影劑,與同期連續(xù)15例放射線下常規(guī)室間隔缺損介入封堵患者比較,在成功率、手術(shù)操作時間、住院時間、術(shù)后并發(fā)癥等方面均無明顯差異(p0.05)。短期內(nèi)隨訪結(jié)果良好。結(jié)果結(jié)論1.食管超聲心動圖引導(dǎo)下行房、室間隔缺損介入封堵術(shù)具有可行性,既保留了常規(guī)介入封堵術(shù)的微創(chuàng)、安全的優(yōu)點,又避免了放射線和對比劑的損害,隨著現(xiàn)有器材的改進有進一步的應(yīng)用前景。2.食管超聲心動圖引導(dǎo)下經(jīng)頸內(nèi)靜脈途徑行房間隔缺損介入封堵術(shù)安全可行,較對照組相比手術(shù)操作時間及臥床時間明顯縮短。3.食管超聲心動圖引導(dǎo)下行室間隔缺損介入封堵術(shù)安全可行,較對照組相比進一步簡化了手術(shù)步驟。
[Abstract]:Objective to study the value of esophageal echocardiography guided (TEE) in interventional closure of atrial septum defect (ASD) and ventricular septum defect (VSD). To explore the feasible materials and methods the clinical data of patients undergoing transcatheter closure of ventricular septum defect under the guidance of esophageal echocardiography in Zhengzhou University people's Hospital (Henan Provincial people's Hospital) from November 2013 to February 2016 were analyzed retrospectively. the clinical data of patients undergoing transcatheter closure of ventricular septum defect under the guidance of esophageal echocardiography were analyzed retrospectively. To summarize the skills and key points of transcatheter closure of atrial and ventricular septum defects under the guidance of esophageal echocardiography. Research: 1. The feasibility of transcatheter closure of atrial septum defect under the guidance of esophageal echocardiography; 2. The feasibility of interventional closure of atrial septum defect through internal jugular vein under the guidance of esophageal echocardiography; 3. The feasibility of transcatheter closure of ventricular septum defect by retrograde catheterization through femoral artery under the guidance of esophageal echocardiography. Patients with conventional atrium and ventricular septum defect were treated with continuous radiation at the same time from operation time, success rate, how much radiation and contrast agent were used, complications, bed rest time, The duration of hospitalization and the results of short-term follow-up after operation were compared to determine the clinical value of transcatheter closure of ventricular septum defect guided by esophageal echocardiography. All 21 patients were successfully treated with transcatheter closure of atrial septum defect under the guidance of esophageal echocardiography, and no radiation was used during the operation, compared with 73 consecutive patients with conventional closure of atrial septum defect under radiation at the same time. There was no significant difference in success rate, operation time, hospitalization time and postoperative complications (p0.05). Interventional closure of atrial septum defect was performed through internal jugular vein in 25 cases under the guidance of esophageal echocardiography. 24 cases were successful and 1 case was double hole atrial septum defect. After macroforamen closure, the microforamen did not completely cover the residual 5mm septum blood flow. The surgical side thoracotomy was successful. No radiation was used in 25 patients, compared with 73 consecutive patients with conventional closure of atrial septum defect under radiation, the basic data were compared with those of 73 consecutive patients with conventional transcatheter closure of atrial septum defect (ASD). There was no significant difference in hospitalization time (p0.05), but the operation time and bed rest time were significantly shorter than those in the control group (p 鈮，

本文編號：2487880