经胸超声与经食管超声引导下经右颈内静脉可调弯鞘封堵小儿房间隔缺损疗效比较

Effect comparison of transthoracic and transesophageal ultrasound-guided transcatheter closure of atrial septal defect in children with adjustable and flexible sheath through right internal jugular vein

摘要:

目的 比较单纯经胸超声（TTE）与经食管超声（TEE）在小儿房间隔缺损（ASD）封堵术中的应用效果。方法 收集2016年1月—2018年1月大连市儿童医院超声引导下经右颈内静脉可调弯鞘封堵ASD患儿的临床资料。按照手术引导方式不同，将患者分为两组。其中60例患者运用TTE引导（TTE组），60例患者运用TEE引导（TEE组）。记录手术时间、临床指标、住院时间及术后预后情况。患儿出院后门诊随访复查胸片、心电图及心脏超声。结果 两组患儿经右颈静脉途径可调弯鞘封堵均获得成功。两组患儿手术时间及住院时间比较，差异无统计学意义（P >0.05）。无周围血管损伤、心内膜炎及心包积液等并发症。术后随访（24.2±4.1）个月，无心律失常、残余分流、封堵器脱落、血栓发生。TTE组未行气管插管和经食管插管。结论 两种超声引导方式均可获得满意的预后，其中TTE引导避免了全身麻醉后气管插管及经食管插管的操作，可杜绝气管及食管出血、穿孔等并发症的发生，更值得临床推广。

Abstract:

Objective To explore the safety and effectiveness of the transthoracic echocardiography (TTE) and the transesophageal echocardiography (TEE) guiding the adjustable curved scabbard through the right internal jugular vein to block atrial septal defect.Methods From June 2017 to June 2019 in our hospital heart center, clinical data of patients underwent adjustable curved scabbard through the right internal jugular vein to block atrial septal defect were collected. According to random number table method, all patients were divided into 2 groups, including TTE guided treatment group (60 cases) and TEE guided control group (60 cases). During the whole operation, the guidewire sheath tube was passed through the ASD under the guidance of TTE or TEE. The operation time, clinical indicators, length of hospital stay, and postoperative prognosis were recorded. After discharge, the patient was followed up for chest radiograph, electrocardiogram, and echocardiography.Results Two groups of children through the jugular vein route adjustable sheath closure were successful. There was no significant statistical difference in operation time and hospital stay between the two groups (P >0.05), and there were no complications such as peripheral vascular injury, intracardiac infection, or pericardial effusion. During the follow-up period of (24.2 ± 4.1) months, there were no arrhythmias, residual shunt, loss of blockages, or thrombosis.Conclusion Satisfactory prognosis can be obtained by both ultrasound guidance methods. TTE guidance can avoid the operation of tracheal intubation and transesophageal intubation after general anesthesia, prevent the occurrence of trachea and esophageal bleeding, perforation and other complications, and is more worthy of clinical promotion.