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目的 评价Rashkind双面伞治疗动脉导管未闭(PDA)的远期疗效。方法 1994年7月至1998年12月,对49例PDA患者施行了Rashkind双面伞封堵术。经股静脉途径置入Rashkind双面伞,封堵后10～30min行主动脉造影。术后24h、1、3、6、12个月及以后每隔6个月行超声心动图和X线胸片检查。结果 47例患者治疗成功,2例进行了外科手术。封堵后10～30min,微量、少量、中量、大量残余分流率分别为12.8％(6/47)、27.7％(13/47)、25.5％(12/47)和14.8％(7/47),完全封堵率19.2％(9/47)。近期(≤3个月)随访36例患者,3个月残余分流率为44.4％(16/36)。中期(3～36个月)随访30例患者,36个月残余分流率为13.3％(4/30)。远期(>36个月)随访25例患者,平均随访时间60±12个月(38～96个月),4例患者仍存在残余分流,其中术后46、48个月有残余分流的2例患者经置入Amplatzer封堵器后达到完全封堵。结论 Rashkind双面伞治疗PDA远期残余分流不能自然消失,需行2次封堵术。
Objective To evaluate the long-term efficacy of Rashkind double-sided umbrella in the treatment of patent ductus arteriosus (PDA). Methods From July 1994 to December 1998, 49 patients with PDA underwent Rashkind double-sided umbrella occlusion. The Rashkind double umbrella was inserted into the femoral vein and the aortography was performed 10 to 30 minutes after the occlusion. Echocardiography and X-ray examination were performed at 6, 1, 3, 6, 12 months after operation and every 6 months thereafter. Results 47 patients were successfully treated and 2 patients underwent surgery. After the occlusion of 10 ~ 30min, trace, small, medium and large residual shunt rates were 12.8% (6/47), 27.7% (13/47), 25.5% (12/47) and 14.8% ), Complete closure rate of 19.2% (9/47). In the recent (≤3 months) follow-up of 36 patients, the 3-month residual shunt rate was 44.4% (16/36). Mid-term (3-36 months) follow-up of 30 patients, 36 months, the residual shunt rate was 13.3% (4/30). In the long term (> 36 months), 25 patients were followed up for a mean follow-up of 60 ± 12 months (38-96 months). Residual shunt was still present in 4 patients, of which residual shunt was 46 and 48 months postoperatively The patient achieved complete occlusion after placement of the Amplatzer occluder. Conclusion Rashkind double-sided umbrella in the treatment of PDA long-term residual shunt can not disappear naturally, the need for 2 occlusions.