右腋下切口外科微创封堵术治疗房间隔缺损  

Minimally invasive occlusion via right infra-axillary incision treating atrial septal defect

作　　者：范太兵[1] 宋书波[1] 梁维杰[1] 董好举[1] 吴开元[1] 李斌[1] 刘琳[1] 彭帮田[1] 

机构地区：[1]河南省人民医院心血管外科,河南省儿童心脏中心,郑州450003

出　　处：《中华实用儿科临床杂志》2015年第7期538-540,共3页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的 探讨经右腋下小切口外科微创封堵房间隔缺损（ASD）的方法及早期随访结果.方法 选取2013年5月至2014年7月在河南省儿童心脏中心经胸和经食管超声心动图筛选后适合封堵的ASD患者,共30例.男12例,女18例.全麻成功后,放置食管超声探头,取左侧卧位,沿腋中线在第3肋间与第5肋间之间做垂直小切口,经第4肋间入胸,在食管超声引导下释放封堵器关闭ASD.结果 28例患者封堵成功,有2例因房间隔缺损较大和下缘短而封堵失败,经原切口改行体外循环手术.1例首次安放不牢固,术中更换大号封堵器;2例双孔ASD采取大号封堵器经大孔一次性封堵成功.心内操作时间3-20（5.0±3.5） min.封堵成功患者均于术后5-9d痊愈出院.随访1-14个月,效果良好,无封堵器脱落、新增瓣膜反流、恶性心律失常等严重并发症.结论 经右侧腋下切口外科微创封堵是一种治疗ASD的新术式,该术式创伤更小,术后渗出少,瘢痕小,切口更隐蔽,若封堵不成功,可经原切口改为体外循环手术,是极具推广价值的创新手术.Objective To discuss the method of minimally invasive occlusion for treating atrial septal defects （ASD） via right infra-axillary and the preliminary results and experience.Methods From May of 2013 to July of 2014,a total of 30 patients （12 male and 18 female） with secundum ASD were examined by transthoracic echocardiography（TTE） and transesophageal echocardiography （TEE） in Henan Provincial Children Heart Center.They were all suitable for occlusion.After induction of anesthesia,the patients were placed in the left lateral position.The incision was performed along right midaxillary line vertically between the third rib and the fifth rib.The thoracic cavity was entered through the fourth intercostal space.The occluder was selected and released under the TEE guidance.Results Twenty-eight patients with ASD were successfully occluded and the operation on two cases failed who received cardiopulmonary bypass operation via original incision.One patient was switched to a larger occluder.Two patients with double defects were occluded successfully by using larger occluders.The intracardiac procedure time ranged from 3 to 20 （5.0± 3.5） min.They were discharged from the hospital 5 to 9 days after the operation.During 1 to 14 months of follow-up,and the clinical effect was good.There was no serious complications occurrence,such as occluder-off,new valvular regurgitation and malignant arrhythmia.Conclusions The placement of ASD occluder through minimal incision of the right infra-axillary is a new method for the occlusion of ASD.This technique is feasible,safe with minor incision and less exudation.If the defect is not occluded successful for one time,cardiopulmonary bypass can be made via the original incision,so it is worthy of clinical application.

关 键 词：房间隔缺损 微创 封堵器 右腋下 

分 类 号：R726.5[医药卫生—儿科]