微创经胸封堵在儿童房间隔缺损中的临床应用  

Microinvasive surgical occlusion for ostium secundum atrial septal defects in children

作　　者：王冲[1,2] 陈志明[1] 张郁林[1] 崔光浩[2] 张步升[1] 

机构地区：[1]复旦大学附属华山医院,上海市200040 [2]扬州大学第四临床医学院南通瑞慈医院心脏外科,江苏省226010

出　　处：《临床小儿外科杂志》2010年第1期9-11,共3页Journal of Clinical Pediatric Surgery

摘　　要：目的探讨经胸微创切口房间隔缺损封堵术治疗房间隔缺损（atrial septal defect，ASD）的临床疗效。方法取胸骨右缘第四肋间切口，长约2～3mm，切开心包并悬吊；于右心房壁缝双荷包线，切开，将输送鞘管插入右心房内，通过缺损入左心房，在超声监测下，释放房间隔缺损封堵伞，行回拉助推试验调整封堵伞位置；确认封堵伞位置合适后结束手术。结果26例封堵成功。手术时间30～85（42±8）min；术后1～9（4．2±3．1）h脱离呼吸机，4～9（5．6±1．2）d出院。术中、术后均未输血。心脏超声检查提示封堵伞无移位，无残余漏，无心内膜炎。瓣膜功能良好。1例封堵不成功病例术中转体外循环下手术获成功。结论微创封堵手术治疗房间隔缺损具有安全、高效的特点，其长期疗效特别是功能影响还需进一步随访评价。Objective To summarize the experience of microinvasive surgical occlusion for ostium secundum atrial septal defects. Methods A total of 27patients with ostium secundum ASD underwent microinvasive surgical occlusion. An incision 2-3cm in length was made on the fight anterior chest. After cutting the pericardium, the fight atrial was sutured with double ring and a special occludinging device was inserted to close the ostium under the guidance of transesophageal echocardiography. Results Of the patients, the procedure was carried uneventfully in 26 cases. The mean operation time was 30 to 85 minutes （mean, 42 minutes）. The patients were discharged from our hospital in 4 to 9 days. No dislocation of the device or atrial shut was found in 3 months after the operation. One patient was convert to open surgery because of failure in the occlusion. Conclusions Microinvasive surgical occlusion is safe and efficient for the closure of ostium secundum ASD. Furthermore, long-term follow-up is needed to exclude possible adverse side effects.

关 键 词：房间隔缺损/外科学 外科手术 微创性 儿童 

分 类 号：R654.2[医药卫生—外科学] R543.5[医药卫生—临床医学]