摘要
目的总结经胸小切口封堵房间隔缺损手术经验与疗效。方法2001年5月-2005年9月，我院采用非体外循环经胸小切口治疗房间隔缺损206例，房间隔缺损直径4．8—44．3mm，其中〉30mm100例，房间隔缺损伴膨出瘤2例。右侧第4肋间做2—3cm小切口，显露右心房并在其外侧壁荷包缝合，将双腔推送导管穿刺人右心房，在食管超声引导下经房间隔缺损送入左心房，并释放直径比房间隔缺损最大径大4mm的镍钛记忆合金封堵器，退出推送导管。结果206例均顺完成手术。手术时间18-32（26±7）min。无手术死亡，无封堵器脱落。术后5h拔除气管插管，患者当日即可下床活动。术后3d复查彩色多普勒，无残余分流。术后住院（4±2）d。186例随访6个月，57例随访3-4．5年，病人恢复良好，彩色多普勒显示均无残余分流，心功能均正常。结论经胸小切口封堵方法治疗房间隔缺损安全可靠，适用于不能介入封堵的房间隔缺撷治疗。
Objective To summarize the experience and efficacy of mlni-incision transthoracic occlusion of atrial septal defect （ASD）. Methods Off-pump mlni-incision transthoracic occlusion of atrial septal defect was conducted in 206 from May 2001 to September 2005 in this hospital, The defect diameter ranged 4. 8 - 44.3 mm and was 〉 30 mm in 100 patients, The ASD was associated with atrial septal aneurysm in 2 patients. An incision 2 - 3 cm in length was made in the 4th intercostal space of the right parasternum to expose the right atrium, at which a purse-string suture was placed, A double-lumen delivery catheter was then punctured into the right atrium, and passed through the defect to the left atrium under the guidance of transesophageal echocardiography. An occluder made of a nickel-titanium metal alloy and 4 mm bigger than the defect was released to engage on the defect, The delivery catheter was then withdrawn. Results The operation was successfully accomplished in all the 206 patients, The operation time was 18 - 32 min（ mean,26 ± 7 min）, No surgery-related death happened and no oceluder dislodgment occurred. Mechanical ventilation was stopped at 5 hours after operation, and all the patients got out of bed on the operation day, Colour Doppler imaging 3 days after operation showed complete occlusion of the ASD without residual shunt, The length of hospitalization was 4 ＋ 2 days, Follow-up examinations for 6 months in 186 patients and for 3 - 4, 5 years in 57 patients by using Colour Doppler imaging revealed no residual shunt and normal cardiac functions. Conclusions Mini-incision transthoraclc occlusion of atrial septal defect is safe and reliable in patients contraindicated to transcatheter closure.
出处
《中国微创外科杂志》
CSCD
2006年第2期113-114,共2页
Chinese Journal of Minimally Invasive Surgery
关键词
经胸小切口
房间隔缺损
封堵器
Transthoracic mini-lncislon
Atrial septal defect
Occluder
