Zuo Chao,Chen Zhi,Xiao Yunbin,et al.Therapeutic strategy and effectiveness of unconventional device application in low-weight children with long patent ductus arteriosus[J].Journal of Clinical Pediatric Surgery,2020,19(10):930-934.[doi:10.3969/j.issn.1671-6353.2020.10.013]
低体重长管型动脉导管未闭非常规封堵器选择策略及效果分析
- Title:
- Therapeutic strategy and effectiveness of unconventional device application in low-weight children with long patent ductus arteriosus
- Keywords:
- Infant; Low Birth Weight; Ductus Arteriosus; Patent; Treatment Outcome
- 分类号:
- R726.2;R654.3
- 摘要:
- 目的 总结低体重长管型动脉导管未闭（patent ductus arteriosus，PDA）患儿使用非常规封堵器介入治疗的效果，为此类患儿选择有效介入治疗方法提供参考依据。方法 收集2017年1月1日至2019年12月31日于湖南省儿童医院行介入封堵治疗的低体重长管型（直径≥3 mm）PDA患儿临床资料，根据选择的封堵器类型分为肌部室间隔缺损（ventricular septal defect，VSD）封堵器和二代Amplatzer PDA封堵器，总结两组患儿的病例特点和并发症发生率。结果 本研究共纳入15例低体重长管型（直径≥3 mm）PDA患儿，年龄4.0（2.0~7.5）个月，平均体重（4.85±1.15）kg；采用肌部VSD封堵器9例，平均体重（5.32±1.17）kg，PDA长度和直径分别为（9.71±1.50）mm和（5.03±1.00）mm。术前平均心胸比为（0.65±0.03），术后心胸比为（0.61±0.03），差异有统计学意义（t=2.3，P=0.04）。3例发生残余瘘，2例出现降主动脉狭窄，5例血小板降低。采用二代Amplatzer PDA封堵器6例，平均体重（4.15±0.75）kg，PDA长度和直径分别为（8.0±0.50）mm和（3.67±0.82）mm；术前平均心胸比为（0.61±0.03），术后平均心胸比为（0.58±0.03），差异有统计学意义（t=2.1，P=0.04）。4例发生残余瘘，1例出现降主动脉狭窄。无一例发生左肺动脉狭窄或封堵器移位、脱落等情况。结论 低体重粗长管型动脉导管未闭通过肌部VSD封堵及二代Amplatzer PDA封堵器，均能获得良好的治疗效果，且能最大限度保护血管；肌部VSD封堵器更适用于动脉导管直径≥5 mm以上患儿，但术后血小板降低发生率较高；二代Amplatzer PDA封堵器适用于动脉导管直径3~5 mm的患儿，需警惕残余瘘及左肺动脉狭窄的发生。
- Abstract:
- Objective To summarize the therapeutic strategy and effectiveness of unconventional device application in low-weight children with long patent ductus arteriosus (PDA).Methods Methods From January 2017 to December 2019,clinical data of low-weight children with long PDA (diameter >3 mm) were retrospectively analyzed.They were divided into two groups of muscular ventricular septal defect (MVSD) and second-generation Amplatzer PDA.Clinical manifestations and incidence of complications were summarized.Results There were a total of 15 patients with an average age of 4(2.0-7.5) months and an average body weight of (4.85±1.15) kg.PDA closure was successfully achieved by MVSD occluder (n=9) or second-generation Amplatzer PDA occluder (n=6).Body weight was (5.32±1.17) kg in MVSD occluder group and (4.15±0.75) kg in second-generation Amplatzer PDA group respectively.And the length and diameter of PDA were (9.71±1.50) and (5.03±1.00) mm in MVSD occluder group and (8.0±0.5) and (3.67±0.82) mm in second-generation Amplatzer PDA group respectively.There were 3 cases of comorbidity with residual shunt in MVSD occluder group and comorbidities with descending aortic stenosis (n=2) and thrombocytopenia (n=5) in MVSD occluder group.Cardiothoracic ratio declined markedly (P<0.05) post-operation compared with pre-operation in MVSD occluder group (0.61±0.03 vs. 0.65±0.03) and second-generation Amplatzer PDA occluder group (0.58±0.03 vs. 0.61±0.03).Comorbidity with residual shunt (n=4) and descending aortic stenosis (n=1) occurred in second-generation Amplatzer PDA occluder group.Dislocation and shift of device or stenosis of left pulmonary was not detected. Conclusion Low-weight children with long PDA (diameter >3 mm) may be effectively treated by MVSD occluder and second-generation Amplatzer PDA occluder.The former is suitable for PDA with a diameter of >5 mm while the latter is ideal for PDA with a diameter of between 3-5mm.
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备注/Memo
收稿日期:2020-02-06。
基金项目:湖南省卫生计生委科研计划课题项目（编号：B2019014）
通讯作者:陈智,Email:eychenzhi@163.com