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目的:评价经导管介入治疗假性室间隔膜部瘤的可行性及安全性,并总结其技术难点与临床策略。方法:226例先天性室间隔缺损伴膜部瘤形成患者,超声测量室间隔缺损直径3~15(4.25±2.71)mm,左心室造影测量室间隔缺损直径2~16(4.37±2.84)mm。应用7~10F输送鞘管从右心系统送入相应封堵器。封堵器直径为4~18(6.24±2.48)mm,封堵后15min重复左心室造影和经胸心脏超声波检查,观察封堵的即刻效果。术后连续心电监护5d。术后1、3个月定期心电图、心脏超声检查。结果:226例中220例患者封堵成功,成功率97.3%。未成功的6例中,4例因多出口囊袋状膜部瘤不能完全封堵而建议外科手术,1例因封堵器放置后影响主动脉瓣关闭,1例因严重心律失常而放弃封堵治疗。206例术后15min左心室造影、经胸心脏超声检查显示完全封堵,14例术后造影示少量分流,1~3个月后超声复查无异常分流。术中并发左、右束支传导阻滞分别为8例和12例,均为一过性,1周内恢复。X线透视时间10~65(15.2±8.8)min,操作时间35~120(42.5±16.2)min。结论:经导管采用封堵器治疗假性室间隔膜部瘤疗效好,安全性高,并发症少,临床应用前景好。技术关键在于对膜部瘤形态的判断以及封堵器的选择。
Objective: To evaluate the feasibility and safety of transcatheter interventional treatment of pseudo-septal melanoma and to summarize its technical difficulties and clinical strategies. Methods: A total of 226 patients with congenital ventricular septal defect and membranous tumor were enrolled. The diameter of ventricular septal defect measured by ultrasound was 3-15 (4.25 ± 2.71) mm and the diameter of ventricular septal defect was 2-16 (4.37 ± 2.84) mm measured by left ventricular angiography. Application 7 ~ 10F delivery sheath from the right heart into the corresponding occluder system. Occluder diameter of 4 ~ 18 (6.24 ± 2.48) mm, 15min after occlusion repeated left ventricular angiography and transthoracic echocardiography to observe the immediate effect of occlusion. Continuous ECG after 5d. 1, 3 months after the regular ECG, echocardiography. Results: Among 226 cases, 220 cases were successfully blocked with a success rate of 97.3%. Of the 6 unsuccessful cases, 4 were recommended surgically because of multiple outlet pocket-pocket meningioma, 1 had closure of the aortic valve due to placement of the occluder, and 1 had been given up due to severe arrhythmia Clogged treatment. 206 cases of left ventricular angiography 15min after operation, thoracic echocardiography showed complete occlusion, 14 cases of postoperative angiography showed a small amount of shunt, 1 to 3 months after ultrasound no abnormal shunt. Intraoperative left and right bundle branch block were 8 cases and 12 cases, were transient, recovered within 1 week. X-ray fluoroscopy time 10 ~ 65 (15.2 ± 8.8) min, operating time 35 ~ 120 (42.5 ± 16.2) min. Conclusion: Transcatheter occluder for the treatment of pseudo-septal meningioma has good curative effect, high safety, few complications and good clinical application. The key to the technique lies in the judgment of the morphology of the membranous neoplasm and the choice of occluder.