右径小切口房间隔缺损封堵术21例临床分析

目的探讨右径小切口房间隔缺损封堵术的方法与疗效。方法回顾性分析我院2004年7月至2005年5月收治的21例房间隔缺损患者,男性8例,女性13例,年龄1～70岁,中位年龄21岁。房间隔缺损直径8～40mm。全麻下右胸骨旁第4肋间行2～3cm切口,在经食管或胸壁超声引导下,经右心房通过单鞘管置入房间隔缺损封堵器。结果全组21例无手术死亡,使用的封堵器型号为14～46mm,均封堵满意,无残余分流,未影响心脏瓣膜功能。无封堵失败改行体外循环手术者。术中未输血,术后未发生封堵器移位或脱落等严重并发症,术后3～5d出院。复查无残余分流,无严重并发症,效果满意。结论右径小切口封堵房间隔缺损安全、创伤小,有一定推广价值。

The clinical report of 21 cases of occlusion of atrial septal defect through right chest small incision

OBJECTIVE: To evaluate the methods and efficacy of atrial septal defect (ASD) occlusion through right chest incision. METHODS: The clinical data of 21 patients with ASD from July 2004 to May 2005 were analyzed retrospectively. Eight patients were male and 13 patients were female, aged from 1 to 70 years old, with the median age of 21 years old. The diameter of ASD was from 8 to 40 mm. All the 21 patients were under general anaesthesia. A 2 to 3 cm incision was made in the 4th intercostals of right side of sternum. With the help of transesophageal or normal transchest echocardiography, the occluder was released using monotubed unit. RESULTS: All cases were occluded successfully without death. The types of the occluder were from 14 to 46 mm. None failed and had to choose extracorporeal circulation operations. No transfusion and no serious complication such as the occluder dislocated occurred. And no evident of atrial shunt was found when in review echo. CONCLUSIONS: The ASD occlusion through right chest minimal incision is safe, credit, minimal invasive and worth to use widely.