微创经胸非体外循环室间隔缺损的封堵治疗  

Minimally invasive transthoracic hybrid therapy for ventricular septal defects without cardiopulmonary bypass

作　　者：王学宁 邓勇志 徐一君 奚吉成 张顺业 

机构地区：[1]山西省心血管病医院心血管外科,太原030024

出　　处：《中华临床医师杂志（电子版）》2012年第24期7983-7986,共4页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的总结微创经胸非体外循环(CPB)下室间隔缺损(VSD)封堵治疗的临床经验。方法 2011年8月至2012年7月,35例VSD患者接受了微创经胸非CPB下VSD封堵治疗,年龄3个月至6岁,体重6.0～31.0kg,VSD直径3～12mm。手术经胸部微创小切口在非CPB下进行,于右心室表面选择适当的穿刺点,在食道超声(TEE)实时引导下,建立输送轨道并完成VSD封堵。术后密切随访1个月至1年。结果 35例中32例封堵成功(91.4%),3例(8.6%)术中改为常规CPB手术。32例患者均无心律失常、残余分流等并发症发生,2例患者发生轻度三尖瓣关闭不全(5.7%)。32例患者均于术后2h内拔除气管插管,3～5d痊愈出院。术后随访无主动脉瓣反流、心律失常、残余分流等并发症发生。结论微创经胸非CPB下VSD封堵治疗是一种安全有效的治疗方法,但远期结果需进一步观察。Objective To summarize the clinical experiences of minimally invasive transthoracic hybrid therapy for ventricular septal defects(VSD)without cardiopulmonary bypass(CPB).Methods A total of 35 patients with VSD,3 months to 6 years,underwent this therapy.The weight of these patients ranged from 6.0 to 31.0 kg.The diameter of their VSDs ranged from 3 to 12 mm.A small transthoracic incision was made.The best location for right ventricular puncture was chosen,the delivery pathway was established and VSD was closed under transesophageal echocardiography(TEE)guidance.Patients were followed up closely from 1 month to 1 year.Results The procedure was completed successfully in 32 cases(91.4%)and converted to traditional surgery with CPB in the other 3 cases(8.6%).No arrhythmia and residual shunt was observed.Mild tricuspid regurgitation was found in 2 cases.All 32 patients were extubated within 2 hours and discharged 3 to 5 days after the operation.During fellow-up period from 1 month to 1 year,no aortic regurgitation,arrhythmia and residual shunt was occurred.Conclusions Minimally invasive transthoracic hybrid therapy for VSD without CPB is proved to be a safe and effective option.Long-term follow-up is indispensable.

关 键 词：室间隔缺损 外科手术 微创性 封堵治疗 非体外循环 

分 类 号：R654.2[医药卫生—外科学]