室间隔缺损修补后残余漏的外科治疗(附18例报告)

目的探讨先天性室间隔缺损(VSD)修补后残余漏的手术疗效及预防VSD残余漏的要点.方法回顾分析了我院19年内收治的VSD修补术后发生残余漏再次手术18例,均为先天性膜部VSD,首次手术中缺损直接缝合修补者4例(直径＜1.0cm),1例术中停体外循环后发现右室表面震颤,立即再次修补,3例术后早期分别因血红蛋白尿、严重心脏杂音及心功能不良再次手术.首次手术中缺损采用补片修补(直径＞1.0cm)14例术后晚期(＞6个月)再次手术,除一例仅因心脏杂音外,其余均因有程度不同的临床症状及x线胸片示心影大、肺血多,ECG示左室肥厚等表现和超声心动图示VSD残余分流明显.结果2例死亡,2例仍存在残余漏,14例痊愈.结论良好的术野显露、准确的手术操作及丰富的手术经验是防止VSD修补后残余漏的主要因素.再次手术应严格掌握指征,手术的关键在于避免损伤性大出血及准确地修补残余漏.

ANALYSES OF 18 CASES WITH RESIDUAL SHUNT OF VSD POSTOPERATIVELY

Objective To investigate the efficacy and safety in patients underwent operation for postoperative residual shunt of ventricular septal defect (VSD). Methods 18 patients ranging in age from 3 to 25 years old underwent operation for postoperative residual shunt of VSD during 18 years were selected and analyzed. Of them 14 cases with large VSD, the defects were primarily closed with a Dacron patch. Of them 4 patients with small VSD, the defects were primarily repaired by direct suture. 4 patients were reoperated in the early period (<6months). 14 patients were reoperated in the late period ( >6months). The principle indication for reoperation based on symptoms, physical examination, and the chest X- ray, electrocardiogram and echocardiogram. Results There were 2 hospital deaths after reoperation. In 2 patient small residual VSD still existed. The next 14 patients were good. Conclusion because of the danger and difficulty for reopening heart surgery, it is recommend that we should pay attention to prevention of residual VSD and adopt a prudent policy to reoperation.