经胸小切口房间隔缺损封堵术41例报告

目的探讨经胸小切口房间隔缺损封堵术治疗房间隔缺损（atrial septal defect,ASD）的疗效。方法胸骨右旁第4肋间切口长3～4 cm,切开心包并悬吊,于右心房壁缝双荷包线,并切开,将输送导管（国产）插入右心房内,通过房间隔缺损口入左心房,在经左胸壁或食道超声监视下,释放出房间隔封堵伞,调整左右侧伞盘夹紧封堵ASD,用保险绳做反复牵拉试验,确认封堵伞位置合适,再做一针贯穿右房壁和伞边缘的褥式缝合固定。结果39例成功封堵,手术时间45～95min,平均60 min;术后住院3～6 d。术后2～24个月复查,心脏彩超检查封堵伞无移位,无残余分流。2例封堵不成功术中转开胸体外循环下完成手术。结论在经胸壁超声监视下房间隔缺损封堵术是一种微创、安全、简便,值得推广的方法。

Occlusion of Atrial Septal Defect via Small Chest Incision: Report of 41 Cases

Objective To discuss the surgical outcomes of atrial septal defects （ASD） by closing the ostium secundum via small chest incision. Methods Totally 41 cases with ASD were treated by occlusion via a small incision （3 -4 cm） at the right anterior chest. After cutting the pericardium, the right atrial was sutured with double ring and a special occluding device was inserted to close the ostium. Afterwards, under the guidance of transthoracical or transesophageal echocardiography, the satisfiable position for the occluder was confirmed by repeated testing with the protect string. After that, the right atrial and the occluder were sutured by a needle thread for fixation. Results Of the patients, the procedure was successfully completed in 39 cases. The mean operation time was 45 to 95 minutes （mean, 60 minutes）. The patients were discharged from our hospital in 3 to 6 days. No dislocation of the device or atrial shut was found in 2 to 24 months after the operation. Two patients were converted to open surgery because of failure in the occlusion. Conclusion Occlusion via small chest incision is safe, minimally invasive, and convenient procedure for ASD.