【摘要】 目的探讨经胸小切口继发孔房间隔缺损(ASD)微创封堵术的可行性及有效性。方法回顾性分析2004年8月至2014年7月收治的140例继发孔房间隔缺损患者,其中男47例、女93例,年龄3~63岁,房间隔缺损直径6~36 mm。患者均于静吸复合全麻下,经右前胸第4肋间小切口进胸,在术中经食管超声(TEE)引导下行房缺封堵术。结果 134例患者经封堵器封堵成功。6例患者因封堵不成功,改行体外循环下ASD修补术。封堵失败原因包括:术后封堵伞脱落2例,均为中央型大ASD,以及术中封堵不成功4例,其中术中TEE发现残余分流2例、筛孔状ASD 1例、术中封堵器脱落1例。术后规律随访,随访期间无严重并发症发生。结论 TEE引导下经胸小切口非体外循环下ASD封堵术安全、有效、创伤小、操作简便,有一定推广价值。更多还原

【Abstract】 Objective To evaluate the feasibility and effectiveness of secundum atrial septal defect(ASD) occlusion with the septal occluder through right-chest small incision. Methods The clinical data of 140 secundum ASD patients(47 males and 93 females) aged 3-63 years who were treated in our center from August2004 to July 2014 were retrospectively analyzed. The diameter of ASD was 6 to 36 mm. Under general anesthesia,all patients underwent intraoperative transtsophageal echocardiography( TEE),during which no associated cardiac deformity was found. All patients received ASD occlusion via a small incision(3-4 cm) at the right anterior chest. The occluders were released with the help of TEE. Results The atrial septal defect closure was successfully completed in 134 cases. Six cases received surgical closure of ASD after the failure of occlusion. The reasons of conversion included postoperative dislodgement of occlusion device( n = 2,both were central type with large size) and technically unsuitable for occlusion( n = 4,in whom residual shunt was found in 2 case,sievepore type in 1 case,and intraoperative dislodgement in 1 case). All of these 6 patients were treated surgically under cardiopulmonary bypass. No dislocation of the device or atrial shunt was found within 3 to 48 months after the operation. Conclusion Occlusion via small chest incision of ASD under TEE guidance without cardiopulmonary bypass is a safe,minimally invasive,effective,and convenient treatment and worth clinical application.更多还原