先天性房间隔、室间隔缺损的经胸微创封堵治疗  

Transthoraic mini-invasive surgical occlusion of atrial and ventricular septal defects

作　　者：曾祥君[1] 丁瑜[2] 虞华[3] 王信杰[3] 种朋贵[2] 郑文庆[4] 方彦鹏[5] ZENG Xiang-jun DING Yu YU Hua WANG Xin-jie CHONG Peng-gui ZHENG Wen-qing FANG Yan-peng(Department of Cardiovascular Surgery, People＇ s Hospital of Guizhou Province, Guiyang Guizhou 550004, China Department of Anesthe- sia, Second Affiliated Hospital of Guiyang College of Traditional Chinese Medicine, Guiyang Guizhou 550001, China Department of Cardio- thoracic Surgery, Second Affiliated Hospital of Guiyang College of Traditional Chinese Medicine, Guiyang Guizhon 550001, China Depart- ment of Cardiology, Second Affiliated Hospital of Guiyang College of Traditional Chinese Medicine, Guiyang Guizhou 550001, China De- partment of Ultrasonography, Second Affiliated Hospital of Guiyang College of Traditional Chinese Medicine, Guiyang Guizhou 550001, China)

机构地区：[1]贵州省人民医院心外科,贵州贵阳550004 [2]贵阳中医学院第二附属医院麻醉科,贵州贵阳550001 [3]贵阳中医学院第二附属医院心胸外科,贵州贵阳550001 [4]贵阳中医学院第二附属医院心内科,贵州贵阳550001 [5]贵阳中医学院第二附属医院超声科,贵州贵阳550001

出　　处：《局解手术学杂志》2017年第6期438-441,共4页Journal of Regional Anatomy and Operative Surgery

摘　　要：目的评估在食道心脏超声引导下经胸微创封堵先天性房、室间隔缺损的疗效及安全性。方法回顾性分析2013年9月至2015年6月贵阳中医学院第二附属医院收治的44例经胸微创封堵心脏房、室间隔缺损患者的临床资料。所有患者术中经食管超声心动图监测并引导封堵伞的放置,评价手术效果,术后门诊定期随访患者心电图、超声心动图。结果 44例患者中43例先天性间隔缺损(室缺28例,房缺16例,其中1例为室缺合并房缺患者)封堵成功,1例室缺患者中转为心内直视手术。手术时间22~48 min,手术切口2~4.5 cm,术后呼吸机辅助时间1~5 h,术后引流量小于50 mL,术后住院时间2~6 d。所有患者均治愈出院。出院病例随访1~12个月,封堵器位置良好,无残余分流,无封堵术导致的瓣膜返流及心律紊乱。结论在食道心脏超声引导下经胸封堵手术治疗先天性房、室间隔缺损具有微创、简便、安全、恢复快等优点,近期随访疗效满意。Objective To investigate the efficacy and safety of transthoracic minimally iuvasive occlusion operation guided by transesophageal echocardiography for the treatment of congenital atrial or/and ventricular septal defects （ASD/VSD）. Methods The clinical data of a total of 44 patients who underwent surgical occlusion operation from September 2013 to June 2015 were summarized. The whole course of occlusion procedure were dynamically monitored and guided by transesophageal echocardiography. All the patients were followed up regularly by electrocardiogram and echocardiograph. Results Among the 44 patients ,43 patients （28 VSDs and 16 ASDs, including one pa- tient suffered with VSD and ASD simultaneously）were occluded successfully, and the other patient with VSD who failed in the surgery was converted to open heart repair. The occlusion operations were finished within 22 to 48 rain. The length of incision spaned from 2 to 4.5 cm. The ventilator was used for 1 to 5 hours. The total drainge volumes were recorded each patient from 0 to 50 mL. The postoperative hospitaliza- tion stay was 2 to 6 days, and all patients survived and were discharged. During the follow-up of 1 to 12 months, there was no cases with A-V conduction block, valve incompetent, cardiac arrhythmia and residual shunt of heart septel defect. Conclusion Transthoraic mini-invasive surgical occlusion of atrial and ventricular septal defects is a therapeutic method with less trauma, higher safety and feasiblity, faster recovery,and the shnrt-term therapeutic effect is satisfying.

关 键 词：房间隔缺损 室间隔缺损 微创 外科封堵术 心脏超声 

分 类 号：R655[医药卫生—外科学] R654.2[医药卫生—临床医学]