食道超声引导下经胸微创室间隔缺损封堵142例报告  

Transesophageal echocardiography guided occlusion of ventricular septal defect via small chest incision： a report of 142 cases

作　　者：席大伟[1] 俞承忠[1] 邱海燕[1] 

机构地区：[1]宁波市妇女儿童医院小儿心胸外科,宁波315012

出　　处：《中国医师杂志》2015年第2期164-165,168,共3页Journal of Chinese Physician

基　　金：浙江省宁波市科技项目（2012C5004）

摘　　要：目的 探讨非体外循环下经胸右室穿刺封堵治疗儿童室间隔缺损（VSD）的经验.方法 2009年3月至2013年12月期间142例先心病VSD患儿,其中男90例,女52例,年龄8个月至11岁,体质量7～35 kg;VSD为膜部、膜周部、肺动脉瓣下型、肌部,缺损直径2～10 mm.均采用全麻下胸骨下段或肋间小切口经右心室穿刺封堵先天性VSD.结果 成功植入VSD封堵器139例,使用封堵伞4 ～ 12#,其中偏心伞25例;2例主动脉瓣关闭不全加重放弃而改常规体外循环下修补缺损,1例房间隔缺损合并肌部室间隔缺损导引钢丝无法通过肌部缺损而不予处理.全组无手术死亡,无Ⅲ度房室传导阻滞并发症.结论 经胸微创封堵术操作简单、手术时间短、适应证相对较广、安全美观,恢复快、效果好.Objective To investigate the experience of microinvasive surgical occlusion of ventricular septal defect （VSD）.Methods A total of 142 children with VSD was given microinvasive surgical occlusion from March 2009 to December 2013 at our hospital.There were 90 males and 52 females,the age ranged from 8 months to 11 years,and body weight from 7 kg to 35 kg,and ventricular septal defects were divided into membranous type,film cycle headquarter type,pulmonary valve type,and muscle type.The diameter of VSD was 2 ～ 10 mm.Under general anesthesia,an incision was made in the lower part of sternum or intercostals space,and a special occluder was inserted to close the ostium via right ventricle puncture under the guidance of transesophageal echocardiography.Results A total of 139 cases had successful occluded with a 97.8% of successful rate,using blocking umbrella 4 ～ 12#,including 25 eccentric umbrella.Two cases were operated under extracorporeal circulation because of aggravated aortic valve insufficiency.One case without handled muscular ventricular septal defect combined atrial septal defect for guide wire pass muscular defect failed.Full set did not have death and third degree A-V block.Conclusions Microinvasive surgical occlusion is easy to handle,operation-time short,and relative broad for the closure of ventricular septal defect.It has a fast recovery and good effectiveness with a beautiful outlook and safety.

关 键 词：室间隔缺损/外科学 心脏导管插入术 胸廓切开术 外科手术 微创性/方法 超声心动描记术 经食管 

分 类 号：R726.5[医药卫生—儿科]