经胸骨剑突上小切口行房间隔缺损封堵及动脉导管未闭缝扎21例报告  

Closure of Atrial Septal Defects and Ligation of Patent Ductus Arteriosus via Supraxiphoid Small Incision Approach: Report of 21 Cases

作　　者：王晨雷 张婧[2] 宋怡[1] 王霁阳[1] 王东坤[1] 张晓羽[1] 甘延清[1] 马润伟[1] 

机构地区：[1]昆明医科大学第四附属医院心血管外科,昆明650021 [2]昆明医科大学第三附属医院神经外科,昆明650100

出　　处：《中国微创外科杂志》2016年第2期134-136,共3页Chinese Journal of Minimally Invasive Surgery

基　　金：云南省科技厅-昆明医科大学应用基础研究联合专项(2014FZ045)

摘　　要：目的 探讨经剑突上小切口行房间隔缺损（atrialseptaldefect，ASD）封堵及动脉导管未闭（patentductusarteriosus，PDA）缝扎术的应用价值。方法2013年7月～2015年5月，对继发孔中央型ASD合并PDA21例（年龄2—11岁），在全麻、气管插管及食道超声引导下，经剑突上1～2em做5em纵行皮肤切口，由剑突向上锯开胸骨，上至第2肋间下缘处向左横行锯开胸骨，行ASD封堵及PDA缝扎术。结果21例均手术成功，术中食道超声及术后3个月复查经胸心脏超声无残余分流。结论经胸骨剑突上小切口ASD封堵及PDA缝扎术操作简单，并发症少，安全、经济，同时避免x线辐射，减少体内封堵器应用，避免体外循环，易于临床推广。Objective To discuss the application value of closure of atrial septal defects （ASD） and ligation of patent ductus arteriosus （PDA） via supraxiphoid small incision approach. Methods A total of 21 patients, aged 2 - 11 years old, with ostium secundum ASD combined with PDA, received closure of ASD and ligation of PDA from July 2013 to May 2015. Under general anesthesia, cndotracheal intubation and transesophageal echocardiography （TEE） , the operation was performed through a longitudinal skin incision （length, 5 era） at 1 -2 cm above the xiphoid process, and the sternum was then sawed upward from the xiphoid process to the inferior border of the 2nd intercostal space with the horizontal sawing of the sternum to the left. Results The operation was successfully performed in all the 21 eases. Intraoperative TEE and 3-month postoperative re-examination of transtboraeic echocardiography （TTE） showed no residual shunt. Conclusions The surgery of ASD closure and PDA ligation via supraxiphoid small incision approach is simple, safe and economical, with few complications. It can also avoid X-ray radiation, reduce the internal usage of occluder, and avoid extracorporal circulation, being suitable for wide application in clinical practice.

关 键 词：经剑突上小切口 房间隔缺损封堵术 动脉导管未闭缝扎术 经食道心脏超声 

分 类 号：R726.5[医药卫生—儿科]