摘要
目的比较交叉连锁褥式缝合法与间断褥式缝合法修补巨型室间隔缺损术后的效果及残余漏发生率。方法回顾性分析2011年2月至2013年4月我院41例巨型室间隔缺损采用交叉连锁褥式缝合法修补术患者的资料。将这41例患者作为交连组,平均年龄(18.7±12.3)岁,男女比例为31:10。按交连组患者相同年龄、室间隔缺损大小及部位、肺动脉压及肺循环阻力共5项指标进行1比1匹配,选择安贞医院心外科同期以间断褥式缝合法修补的巨型室间隔缺损患者41例作为对照组,平均年龄(17.4±11.8)岁,男女比例为31:10,进行回顾性配对对照分析。结果全组无手术死亡,无围术期新发房室传导阻滞发生。围术期经超声检查发现对照组残余漏发生率为31.7%(13/41),交连组为0%(0/41),两组差异有统计学意义(χ2=13.164,P=0.000)。两组患者平均随访(18.2±6.1)个月,随访期内均无死亡,无新房室传导阻滞发生。术后1年两组在纽约心脏病学会心功能分级、经超声心动图检测肺动脉压的差异均无统计学意义。术后12个月复查超声心动图,对照组残余漏发生率为26.8%(11/41),交连组为0%(0/41),两组差异有统计学意义(χ2=10.499,P=0.001)。结论间断褥式缝合法修补合并中、重度肺动脉高压的巨型室间隔缺损术后的残余漏发生率较高,而采用交叉连锁褥式缝合法可有效减少残余漏的发生率。
Objective To investigate the effect and incidence of residual leakage after surgical repair of large ventricular septal defects with moderate to severe pulmonary hypertension using cross-linkage mattress suture, a suture method invented by us, as compared with interrupted mattress suture. Methods We retrospectively analyzed the clinical data of 41 patients of large ventricular septal defect with moderate to severe pulmonary hypertension underwent surgery using cross-linkage mattress suture in Beijing Anzhen Hospital from February 2011 through April 2013. The 41 patients were as a cross-linkage group （average age 18.7±12.3 years, the ratio of male to female 31 ： 10）. Another 41 patients, who were repaired using interrupted mattress suture, were retrospectively chosen by matching age, size and location of the defects, pulmonary artery pressure and vascular resistance with members from the cross-linkage group, and were assigned as a control group （average age 17.4±11.8 years, the ratio of male to female 31 ： 10）. Results There was no operative mortality and no new perioperative atrioventricular conduction block. Postoperative echocardiography revealed the incidence of residual leakage was 31.7% （13/41） in the control group, 0% （0/41） in the cross-linkage group with a statistical difference （X2=13.164, P=0.000）. With a follow-up of 18.2 ±6.1 months, no late death and no new atrioventricular conduction block occurred. There was no statistical difference in New York Heart Association functional class or pulmonary artery pressure measured through echocardiography between the two groups. While there was a statistical difference in incidence of residual leakage between the the cross-linkage group and the control group （0% （0/41） versus 26.8% （11/41）, X2=10.499, P=0.001）. Conclusion There is a high incidence of residual leakage after the surgical repair of large ventricular septal defect complicated with moderate to severe pulmonary hypertension using interrupted mattress suture, whil
出处
《中国胸心血管外科临床杂志》
CAS
CSCD
2016年第3期234-238,共5页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
基金
国家自然科学基金(81070041)
北京市卫生系统高层次卫生人才队伍建设专项经费(学科带头人)(2013-2-02)
北京市科技计划项目(Z121107001012067)~~
关键词
室间隔缺损
外科治疗
肺动脉高压
Ventricular septal defect
Surgical repair
Pulmonary hypertension
