儿童动脉导管未闭介入堵闭术的临床疗效评价

目的评价分别运用弹簧圈（Coil）和Amplatzer封堵器（ADO）堵闭小型和中一大型动脉导管未闭（PDA）的临床疗效。方法对1998年5月至2006年1月在我院接受介入封堵术的112名PDA患儿进行回顾性队列研究。结果植入Coil和ADO的患儿分别为19例和93例。AIX）组患儿PDA最窄处直径为1．7～11．0mm，（平均3．53mm），显著高于Coil组患儿1．0～3．3mm（平均1．76mm），P〈0．001。全部患儿均成功完成介入封堵术（100％）。1年随访期中，残余分流率在不同随访时间点分别为Coil组31．6％（即刻）、26．3％（24h）、5．3％（1～3月）、5．3％（9～12月）和ADO组21．5％、6．5％、2．2％和1．2％。近期并发症2例，溶血1例，心律失常1例。远期随访中无溶血、PDA再通和左肺动脉或降主动脉狭窄；无患儿因残余分流需要再次接受介入治疗。结论选择合适的堵闭器经导管介入封堵治疗儿童PDA疗效确切，安全性好。

Assessment of the transcatheter closure of patent ductus arteriosus in children

Purpose To evaluate efficacy of transcatheter occlusion with the coil for small size and with Amplatzer duct occluder(ADO) for moderate-to-large size patent ductus arteriosus(PDA). Methods A retrospective cohort study was couducted in a total of 112 pediatric patients with PDA with transcatheter closure from May 1998 to January 2006. Results The devices were successfully implanted in all 112 patients(100%).Coils were implanted in 19 and ADOs in the 93 patients.The minimal diameters of PDA in the ADO group were from 1.7 to 11.0(mean 3.53)mm,whereas those in the Coil group were from 1.0 to 3.3(mean 1.76)mm(P<0.001).Eventually the devices were successfully implanted in all 112 patients(100%).The residual shunt rates during one year follow-up period were 31.6%(immediate),26.3%(24 hour),5.3%(1-3 months)and 5.3%(9-12 months) in the Coil group,compared with 21.5%,6.5%,2.2% and 1.2% in the ADO group,respectively.Early complications were found in two patients for hemolysis and arrhythmia.No hemolysis,recanalization and stenosis of left pulmonary or aorta were found during further follow-up.No patient required re-intervention to treat residual shunt. Conclusions Transcatheter PDA occlusion with appropriate occluder is generally a very effective and safe procedure for children.