2022 年第 9 期 第 17 卷

卵圆孔未闭封堵术对合并隐匿性脑卒中或偏头痛患者的近中期疗效观察

Short and mid-term efficacy of closure of patent foramen ovale on treating patients complicated with cryptogenic stroke or migraine

作者：梁永梅王霄芳叶文倩上官文王志远李强强杨一妃李晓雪金梅

英文作者：Liang Yongmei Wang Xiaofang Ye Wenqian Shangguan Wen Wang Zhiyuan Li Qiangqiang Yang Yifei Li Xiaoxue Jin Mei

单位：首都医科大学附属北京安贞医院小儿心脏中心北京市心肺血管疾病研究所，北京100029

英文单位：Pediatric Cardiac Center Beijing Anzhen Hospital Capital Medical University Beijing Institute of Heart Lung and Blood Vessel Diseases Beijing 100029 China

关键词：卵圆孔未闭；隐匿性卒中；偏头痛；经皮介入封堵

英文关键词：Patentforamenovale;Cryptogenicstroke;Migraine;Percutaneousinterventionalocclusion

• 摘要：

• 目的 探讨卵圆孔未闭（PFO）封堵术对合并隐匿性脑卒中（CS）或偏头痛患者的近中期疗效。方法  选取首都医科大学附属北京安贞医院2013年10月至2020年12月诊断PFO合并CS或偏头痛的189例患者的临床资料进行回顾性分析。所有患者接受PFO封堵术治疗。记录患者的临床资料，对患者是否再发脑卒中以及偏头痛是否缓解进行随访。结果  189例PFO患者中，合并CS 121例（64.0%），合并偏头痛68例（36.0%）。161例（85.2%）患者PFO封堵成功，28例（14.8%）患者因卵圆孔细小未能成功封堵卵圆孔。围术期均未出现封堵器移位、脱落、栓塞。所有患者无心包填塞、恶性心律失常、死亡等严重手术并发症。随访期间，失访28例，其余161例患者中位随访时间51个月。103例合并CS患者中，PFO封堵成功患者再发脑卒中比例明显低于未封堵成功患者［0（0/90）比15.4%（2/13）］（χ2=7.414，P=0.006）。58例合并偏头痛患者中，PFO封堵成功患者偏头痛未缓解比例与未封堵患者比较差异无统计学意义［46.8%（22/47）比36.4%（4/11）］（χ2=0.580，P=0.446）。结论 PFO封堵术具有较好的安全性，对合并CS患者的疗效确切，对合并偏头痛的患者可能有一定疗效。

• Objective  To explore the short and mid-term efficacy of closure of patent foramen ovale (PFO) on treating patients complicated with cryptogenic stroke (CS) or migraine. Methods  Clinical data of 189 patients of PFO complicated with CS or migraine in Beijing Anzhen Hospital, Capital Medical University from October 2013 to December 2020 were retrospectively analyzed. All patients received closure of PFO. Clinical data of patients were recorded, and the status of recurrent stroke and relief of migraine were followed-up. Results  Among 189 patients, 121 cases (64.0%) were complicated with CS, and 68 cases (36.0%) were complicated with migraine. There were 161 cases (85.2%) of PFO occluded, and 28 cases (14.8%) of PFO were not occluded because the PFO was small. There was no displacement, falling off or embolism of occluder in the perioperative period. All patients had no serious complications such as pericardial tamponade, malignant arrhythmia and death. During follow-up, 28 cases lost, and remaining 161 cases had the median follow-up duration of 51 months. Among 103 cases complicated with CS, the incidence of recurrent stroke in patients with PFO occluded was lower than that in patients with PFO not occluded［0（0/90） vs 15.4%（2/13）］(χ2=7.414, P=0.006). Among 58 cases complicated with migraine, there was no significant difference in the incidence of migraine not relieved between patients with PFO occluded and not occluded ［46.8%（22/47） vs 36.4%（4/11）］(χ2=0.580, P=0.446). In patients with PFO occluded, no residual shunt was found by transthoracic echocardiography. Conclusion  Closure of PFO is safe, and has definite curative effect on patients complicated with CS. However, it may have curative effect on patients complicated with migraine.