儿童继发孔房间隔缺损经右心房微创封堵术的临床评估  

Evaluation of minimally invasive peratrial device closure of secundum atrial septal defects in children

作　　者：尹倪[1] 赵天力[1] 杨一峰[1] 徐新华[1] 王欣[1] 吴勤[1] 高雷[1] 陈金兰[1] 

机构地区：[1]中南大学湘雅二医院心胸外科,长沙410011

出　　处：《中南大学学报（医学版）》2011年第6期576-580,共5页Journal of Central South University ：Medical Science

摘　　要：目的:探讨一种新型非体外循环下,经食管超声引导,通过右心房穿刺,封堵继发孔房间隔缺损的手术方法,总结其在患儿中应用的临床经验。方法:选取115名继发孔房间隔缺损患儿作为封堵组,采用正中胸骨下段小切口,非体外循环下,经右心房穿刺,采用食管超声引导封堵器闭合缺损,术后严密随访1～13月。同期59例继发孔房间隔缺损患儿作为循环组,采用体外循环下直视修补手术。比较两组患儿在手术过程、术后恢复和并发症方面的差异。结果:封堵组除1例发生封堵器移位,其余114例封堵成功。封堵组手术时间、机械通气时间、监护室停留时间、住院时间和输血率均显著低于循环组(P<0.01),而各类并发症与循环组无明显差异(P>0.05)。结论:非体外循环下食管超声引导经右心房穿刺封堵儿童继发孔型房间隔缺损,是一种相对简单、安全、有效的新型手术方法。短中期随访结果显示良好,远期效果有待进一步观察。Objective To introduce peratrial device closure of secundum atrial septal defects（ASD） under the guidance of transesophageal echocardiography（TEE） without cardiopulmonary bypass（CPB） in children,and to summarize the clinical experiences.Methods A total of 115 children with secundum ASD（the occlusion group） underwent peratrial device closure of atrial septal defects through a small sternotomy under TEE guidance without cardiopulmonary bypass.Children were followed up closely for 1-13 months.Another 59 children（the bypass group） had closed atrial septal defects under cardiopulmonary bypass during the same period.The differences in the operation duration,convalescence and complication between the 2 groups were compared.Results Except 1 patient was operated under the CPB,the rest 114 patients in the occlusion group were successfully closed by the occluders.The duration of the operation,mechanical ventilation,intensive care and hospitalization,and the rate of blood-transfusion in the occlusion group were significantly lower than those in the bypass group（P0.01）,with no difference in complications in the 2 groups（P0.05）.Conclusion Minimally invasive peratrial device closure of ASD without CPB is a relatively simple,safe and effective operation under the guidance of TEE for children.The short and mid-term clinical outcomes are promising.Long-term follow-up is indispensable.

关 键 词：微创 继发孔房间隔缺损 封堵术 食管超声心动图 

分 类 号：R726.5[医药卫生—儿科]