706例婴幼儿先天性室间隔缺损的手术治疗

目的总结婴幼儿室间隔缺损(VSD)手术治疗的临床经验。方法1992年12月~2005年9月手术治疗婴幼儿VSD706例,男417例,女289例,月龄0.067~36个月,平均(14.6±8.7)月。体重3~22.5kg,平均(10.8±8.3)kg,小于10kg者476例(67.4%)。均在低温体外循环下手术,必要时应用深低温低流量及改良超滤技术。直视缝合436例,补片修补270例。干下型VSD应早期手术,防止主动脉瓣关闭不全的发生。术后应重视对呼吸系统、循环系统的监护与治疗,重视对肺动脉高压围术期处理。结果术后30d内死亡18例(其中11例年龄小于6个月),死亡率2.55%,晚期死亡1例。主要并发症发生率11.2%。结论婴幼儿VSD修补术可取得满意的效果,但小于6个月龄以内的低体重婴儿手术适应症应严格控制。

Surgical Treatment of congenital Ventricular Septal Defect in 706 infants

Objective To review the clinical experience of the surgerical treatment of ventricular septal defect (VSD) in infants. Methods From Dec.1992 to Sep. 2005, 706 infants ( 417 males,289 females )were operated on for their VSD. Their ages ranged from 0.067 to 36 months (14.6±8.7 months ). Their body weight ranged from 3 to 22.5 kg.(10.8±8.3kg).476 cases were less than 10 kg (67.4%).All patients underwent VSD repair under hypothermic anaesthesia with cardiopulmonary bypass. If necessary, deep hypothermic and low flow, improved superfilter was used.436 cases were repaired with direct stitch closure and 270 with patch closure. Subpulmonary VSD should be repaired early to prevent aortic insufficiency. The care and therapy of the respiratory system and circulatory system must be paied attention to after operation. The monitor and treatment of peroperative pulmonary hypertension must be thought highly of, too. Results There were 18 deaths (10 infants who less than 6 months, one new born ), with operative mortality of 2.55%. One infant died 66 days after operation. The morbidity was 11.2%. Conclusion The satisfactory result can be acquired in infantile operation of VSD. But, the operative indication about the infants who less than 6 months must be control strictly.