微创医学

目的观察超声引导下经胸封堵手术对先天性心脏病患儿心肌重构的影响。方法选取接受手术治疗的先天性心脏病患儿90例，根据治疗方法分为观察组（51例）与对照组（39例），其中对照组给予经皮介入封堵术，观察组给予超声引导下经胸封堵手术。记录两组患儿手术成功率、手术时间、术中出血量、输血量、呼吸机辅助时间、住院时长及并发症发生情况，并观察术前、术后3个月心肌重构及随访1年的预后情况。结果观察组患儿手术成功率（98.04%）高于对照组（82.05%），手术时间、呼吸机辅助时间及住院时长均短于对照组，且术中出血量与输血量少于对照组（均P＜0.05）；术后3个月，两组左心室内径（LVD）、左心房内径（LAD）、右心房内径（RAD）及右心室内径（RVD）均较术前显著改善，且观察组改善程度优于对照组（均P＜0.05）。观察组术后并发症发生率低于对照组；术后随访1年观察组封堵器脱落、残余分流、心包积液等不良预后发生率低于对照组（均P＜0.05）。结论相比于经皮介入封堵术，超声引导下经胸封堵手术治疗先天性心脏病的效果更优，不仅能改善患儿心肌重构，而且能降低并发症发生率，此外还能缩短住院时长，对于改善预后也具有积极作用，值得临床推广应用。

ObjectiveTo observe the effect of ultrasound-guided transthoracic occlusion surgery on myocardial remodeling in children with congenital heart disease. MethodsA total of 90 children with congenital heart disease received surgery were selected and assigned to observation group (51 cases) and control group (39 cases) according to the therapy options, among which the control group received percutaneous interventional occlusion, whereas the observation group received ultrasound-guided transthoracic occlusion surgery. The surgery success rate, surgery time, intraoperative bleeding volume, blood transfusion volume, ventilator assistance time, hospitalization time and the occurrence of complications were recorded in both groups, as well as the conditions of myocardial remodeling before and 3 months after surgery and of prognosis 1 year of follow-up were observed. ResultsAs compared with the control group, the observation group yielded higher surgery success rate (98.04% vs. 82.05%), shorter time of surgery, ventilator assistance and hospitalization, and less volume of intraoperative bleeding and blood transfusion (all P＜0.05). After 3 months of surgery, the left ventricular diameter (LVD), left atrial diameter (LAD), right atrial diameter (RAD), and right ventricular diameter (RVD) of both groups significantly improved compared with those before surgery, and the improvements of the abovementioned indicators in the observation group were superior to those in the control group (all P＜0.05). The postoperative complications rate was lower in the observation group than in the control group; furthermore, the observation group yielded lower incidence of adverse reactions including occluder devices fall-off, residual shunt, pericardial effusion as compared with the control group after 1 year of follow-up. ConclusionCompared with percutaneous interventional occlusion, ultrasound-guided transthoracic occlusion surgery in treating congenital heart disease has superior effects, which can not only improve myocardial remodeling in children, but also decrease the incidence of complications; in addition, it can also shorten hospitalization time, and has positive effect on prognosis improvement, and thus it is worthy of promotion and application.