经胸微创封堵术治疗房间隔及室间隔缺损143例疗效观察  

Curative effect of thransthoracic minimally invasive occlusion in the treatment of atrial septal defect and ventricular septal defect: a report of 143 cases

作　　者：林巍[1] 符芳永 卢伟[1] 伍成德 马西淼 林刚[1] LIN Wei;FU Fang-yong;LU Wei;WU Cheng-de;MA Xi-miao;LIN Gang(First Department of Cardiothoracic Surgery, Haikou Hospital Affiliated to Xiangya School of Medicine, Central South University, Haikou 570208, Hainan, CHINA)

机构地区：[1]中南大学湘雅医学院附属海口医院心胸外一科,海南海口570208

出　　处：《海南医学》2019年第5期622-624,共3页Hainan Medical Journal

基　　金：2016年度海南省卫计委科研项目(编号:2016-SWJW-05-011)

摘　　要：目的总结我院微创经胸非体外循环房间隔缺损、室间隔缺损封堵伞封堵术的临床应用经验。方法中南大学湘雅医学院附属海口医院心胸外科2010年5月至2018年5月对64例房间隔缺损(ASD)和79例室间隔缺损(VSD)患者进行经胸微创房间隔缺损、室间隔缺损封堵术。全麻下取右胸胸骨旁第4肋间3～4 cm切口(适用于漏斗部房间隔缺损)或胸骨下段5 cm小切口(膜部室间隔缺损)或左胸胸骨旁第2、3肋间3～4 cm切口(适用于室间隔缺损)入胸,在食管超声(TEE)监测下选择合适的封堵器,在超声引导下释放封堵器封堵ASD、VSD。术中通过TEE观察有无残余漏,有无影响附近瓣膜的活动。结果 136例患者手术成功,术中、术后均未输血,手术时长为25～45 min,平均住院5～7 d。随访3～26个月,超声检查未发现明显残余分流及封堵器位置异常。7例VSD患者改常规开胸手术,术后复查心脏彩超未见异常。结论微创经胸非体外循环封堵术是治疗房间隔缺损、室间隔缺损的一种行之有效的微创手术治疗方法,操作简单,安全性高,具有临床推广应用价值。Objective To summarize the clinical application experience of atrial septal defect occlusion and ventricular septal defect occlusion by minimally invasive transthoracic with off-pump ways in our hospital. Methods From May 2010 to May 2018, transthoracic minimally invasive atrial septal defect occlusion and ventricular septal defect occlusion were performed in 64 patients with secondary atrial septal defect(ASD) and 79 patients with ventricular septal defect(VSD) in Department of Cardiothoracic Surgery, Haikou Hospital Affiliated to Xiangya School of Medicine, Central South University. Under general anesthesia, the 4 thintercostal 3-4 cm incision of the right thoracic sternum(for ASD) or the 5 cm small incision of the lower sternum(membrane VSD) or the left thoracic 2 ndand 3 rdintercostal 3-4 cm incision(SPVSD) into the chest were taken. Under the monitoring of transesophageal echocardiography(TEE), the appropriate occluder was selected, and the occluder was released under the guidance of ultrasound to occlude ASD or VSD. During the operation, the esophageal ultrasound(TEE) was used to observe whether residual shunt exist or whether it affects the activity of the nearby valves. Results Successful operation was performed in 136 patients, and there was no blood transfusion during operation or after operation. The duration of operation was 25 to 45 minutes, and the average hospitalization was 5 to 7 days. After 3 to 26 months of follow-up, no obvious residual shunt and displacement of occluder were found by ultrasonography. Seven patients of VSD group were replaced by conventional thoracotomy.There was no abnormality in postoperative ultrasoundcardiogram(UCG). Conclusion Minimally invasive transthoracic occlusion with off-pump is an effective minimally invasive surgical treatment for atrial septal defect and ventricular septal defect. It is simple in operation, high in safety, and has clinical application value.

关 键 词：房间隔缺损 室间隔缺损 封堵伞 封堵术 食道心脏超声 疗效 

分 类 号：R654.2[医药卫生—外科学]