[1]伊寒露,叶赞凯,朱耀斌,等.单纯食道超声心动图引导下经腋下小切口儿童动脉导管未闭的封堵治疗[J].临床小儿外科杂志,2023,22(08):737-740.[doi:10.3760/cma.j.cn101785-202208014-007]
　Yi Hanlu,Ye Zankai,Zhu Yaobin,et al.Treatment of patent ductus arteriosus in children through small axillary incision by esophageal echocardiography-guided only[J].Journal of Clinical Pediatric Surgery,2023,22(08):737-740.[doi:10.3760/cma.j.cn101785-202208014-007]
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单纯食道超声心动图引导下经腋下小切口儿童动脉导管未闭的封堵治疗

《临床小儿外科杂志》[ISSN:1671-6353/CN:43-1380/R] 卷: 第22卷 期数: 2023年08 页码: 737-740 栏目: 论著 出版日期: 2023-08-28
Title:
Treatment of patent ductus arteriosus in children through small axillary incision by esophageal echocardiography-guided only
作者:
伊寒露1;  叶赞凯1;  朱耀斌1;  丁楠1;  沈磊2;  郭健1;  李志强1
1. 国家儿童医学中心 首都医科大学附属北京儿童医院心脏外二科, 北京 100045;
2. 国家儿童医学中心 首都医科大学附属北京儿童医院心脏监护病房, 北京 100045
Author(s):
Yi Hanlu1;  Ye Zankai1;  Zhu Yaobin1;  Ding Nan1;  Shen Lei2;  Guo Jian1;  Li Zhiqiang1
1. Department II of cardiac surgery, Cardiac Center, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, China, 100045;
2. Cardiac Care Unit, Department of Critical Care Medicine, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 100045, China
关键词:
动脉导管未闭; 经食道超声心动图; 心间隔封堵装置; 心脏外科手术; 治疗结果; 儿童
Keywords:
Ductus Arteriosus;  Patent; transesophageal echocardiography; Septal Occluder Device; Cardiac Surgical Procedures; Treatment Outcome; Child
DOI:
10.3760/cma.j.cn101785-202208014-007
摘要:
目的 探讨经食道超声心动图引导、左侧腋下小切口入路行儿童动脉导管未闭封堵治疗的安全性、有效性及可行性。方法 本研究为回顾性研究。收集2018年3月至2021年12月首都医科大学附属北京儿童医院收治的动脉导管未闭患儿40例作为研究对象，其中男13例、女27例，年龄1.09（0.60，1.75）岁，体重9.00（7.20，10.50） kg，均行单纯食道超声心动图引导下左侧腋下小切口入路动脉导管未闭封堵术，均手术顺利，术后返回心脏重症监护室予对症治疗，必要时予强心、利尿治疗。收集所有患儿术后即刻以及术后1个月、3~6个月随诊超声心动图及心电图情况，评估治疗效果。结果 40例均封堵成功，1例术后3个月复查时发现封堵器移位，患儿无明显不适，予取出封堵器及动脉导管切断缝合术，手术顺利。其余39例术后随诊超声心动图及心电图均提示封堵器位置良好，心脏各房室内径基本正常；无一例出现残余分流、心包积液、心律失常等并发症。结论 单纯经食道超声心动图引导下左侧腋下小切口入路行儿童动脉导管未闭封堵术安全有效，对小年龄、低体重、伴有粗大动脉导管未闭的患儿同样适用，具有切口小、康复快、并发症少等优点。
Abstract:
Objective To explore the safety, effectiveness and feasibility of patent ductus arteriosus (PDA) occlusion in children under the guidance of transesophageal echocardiography (TEE) via a small left axillary incision.Methods Clinical data were retrospectively reviewed for 40 PDA children between March 2018 and December 2021.There were 13 boys and 27 girls with an age range of 1.09(0.60-1.75) years and a body weight of 9(7.20-10.50) kg.Simple esophageal heart ultrasound-guided small incision was performed in left axilla for PDA closure.Return to the intensive care unit after the operation for symptomatic treatment and, if necessary, cardiotonic and diuretic treatment.Both echocardiogram and electrocardiogram were examined immediately, Month 1 post-operation and Month 3-6 post-operation for evaluating the treatment outcomes.Results The occluder was successfully implanted in all children.At Month 3 post-operation, occluder was displaced in one child without any obvious discomfort.The occluder was removed, arterial catheter withdrawn and skin sutured.In the remainders, follow-up cardiac color Doppler ultrasound and electrocardiogram indicated that the position of occluder was excellent and internal diameter of each atrium was basically normal.There were no complications such as residual shunt, pericardial effusion or arrhythmia.Conclusion It is safe and effective to occlude PDA with a small left axillary incision under the sole guidance of esophageal echocardiography in children.Such an approach is also suitable for young and underweight children with thick PDA.It offers the advantages of minimal trauma, faster recovery and fewer complications.

参考文献/References:

[1] Mo? C.Patent ductus arteriosus[J].Med Ultrason, 2010, 12(2):153-156.
[2] Baumgartner H, Bonhoeffer P, De Groot NMS, et al.ESC guidelines for the management of grown-up congenital heart disease (New Version 2010)[J].Eur Heart J, 2010, 31(23):2915-2957.DOI:10.1093/eurheartj/ehq249.
[3] Baruteau AE, Hasco?t S, Baruteau J, et al.Transcatheter closure of patent ductus arteriosus:past, present and future[J].Arch Cardiovasc Dis, 2014, 107(2):122-132.DOI:10.1016/j.acvd.2014.01.008.
[4] 应力阳, 刘喜旺, 谭征, 等.达芬奇机器人手术在儿童动脉导管未闭中的应用研究[J].临床小儿外科杂志, 2021, 20(12):1179-1182.DOI:10.12260/lcxewkzz.2021.12.015. Ying LY, Liu XW, Tan Z, et al.Application of Da Vinci robot assisted endoscopic technique for patent ductus arteriosus in children[J].J Clin Ped Sur, 2021, 20(12):1179-1182.DOI:10.12260/lcxewkzz.2021.12.015.
[5] 左超, 陈智, 肖云彬, 等.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[J].临床小儿外科杂志, 2020, 19(10):930-934.DOI:10.3969/j.issn.1671-6353.2020.10.013. Zuo C, Chen Z, Xiao YB, et al.Therapeutic strategy and effectiveness of unconventional device application in low-weight children with long patent ductus arteriosus[J].J Clin Ped Sur, 2020, 19(10):930-934.DOI:10.3969/j.issn.1671-6353.2020.10.013.
[6] Schubert S, Kainz S, Peters B, et al.Interventional closure of atrial septal defects without fluoroscopy in adult and pediatric patients[J].Clin Res Cardiol, 2012, 101(9):691-700.DOI:10.1007/s00392-012-0445-1.
[7] Ait-Ali L, Andreassi MG, Foffa I, et al.Cumulative patient effective dose and acute radiation-induced chromosomal DNA damage in children with congenital heart disease[J].Heart, 2010, 96(4):269-274.DOI:10.1136/hrt.2008.160309.
[8] Walsh MA, Noga M, Rutledge J.Cumulative radiationexposure in pediatric patients with congenital heart disease[J].Pediatr Cardiol, 2015, 36(2):289-294.DOI:10.1007/s00246-014-0999-y.
[9] Marenzi G, Lauri G, Assanelli E, et al.Contrast-induced nephropathy in patients undergoing primary angioplasty for acute myocardial infarction[J].J Am Coll Cardiol, 2004, 44(9):1780-1785.DOI:10.1016/j.jacc.2004.07.043.
[10] 欧阳文斌, 胡盛寿, 王珊, 等.经胸微创封堵术治疗婴幼儿动脉导管未闭的临床研究[J].中国循环杂志, 2015, 30(10):967-970.DOI:10.3969/j.issn.1000-3614.2015.10.010. Ouyang WB, Hu SS, Wang S, et al.Clinical trial of transthoracic mini-invasive patent ductus arteriosus occlusion in infants and young children[J].Chin Circul J, 2015, 30(10):967-970.DOI:10.3969/j.issn.1000-3614.2015.10.010.
[11] 吴澄, 钟小梅.超声引导下经皮及经胸房间隔缺损封堵术的对比研究[J].临床医药实践, 2018, 27(3):180-182.DOI:10.16047/j.cnki.cn14-1300/r.2018.03.007. Wu C, Zhong XM.Comparative study on ultrasound-guided percutaneous and transcatheter closure of thoracic atrial septal defect[J].Proc Clin Med, 2018, 27(3):180-182.DOI:10.16047/j.cnki.cn14-1300/r.2018.03.007.
[12] 闫振, 张为民, 隋丰光, 等.分析总结儿童房间隔缺损经皮介入治疗的并发症的发生率、危险因素及处理方法[J].健康之友, 2019, (17):97-98. Yan Z, Zhang WM, Sui FG, et al.To analyze and summarize the incidence, risk factors and management of complications in children with Atrial septal defect after percutaneous intervention[J].Healthful Friend, 2019, (17):97-98.
[13] 国家卫生健康委员会国家结构性心脏病介入质量控制中心, 国家心血管病中心结构性心脏病介入质量控制中心, 中华医学会心血管病学分会先心病经皮介入治疗指南工作组, 等.常见先天性心脏病经皮介入治疗指南(2021版)[J].中华医学杂志, 2021, 101(38):3054-3076.DOI:10.3760/cma.j.cn112137-20210730-01696. National Structural Heart Disease Intervention Quality Control Center of National Health Commission, National Cardiovascular Center for Structural Heart Disease Intervention Quality Control Center, Working Group on Guidelines for Percutaneous Interventional Treatment of Congenital Heart Disease, Cardiovascular Branch, Chinese Medical Association, et al.Guidelines for Percutaneous Intervention Therapy of Common Congenital Heart Defect (Version 2021)[J].Natl Med J China, 2021, 101(38):3054-3076.DOI:10.3760/cma.j.cn112137-20210730-01696.

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备注/Memo

收稿日期:2022-08-06。
基金项目:北京市医院管理中心儿科学科协同发展中心专项经费资助（XTYB201819）
通讯作者:李志强,Email:lizhiqianganzhen@yeah.net

更新日期/Last Update: 1900-01-01