经右胸小切口微创房间隔缺损封堵术67例

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。方法右侧胸骨旁第4肋间切口长3～4cm,于膈神经上方切开心包并悬吊,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67例成功封堵,手术时间38～95min,平均46min;术后住院3～8d。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。

Intraoperative Device Closure Of Secundum Arrial Septal Defect With Aright Anterior Minithoracotomy In 67 Patients

Objective To discuss the surgical outcomes of atrial septal defects （ASD） by closing the ostium secundum viasmall chest incision. Methods Totally 67 caseswith ASD were treated by occlusion via a small incision （3-4cm） at the rightanterior chest. After cutting the pericardium, the right atrialwas sutured with double ring and a special occluding devicewas insertedto close the ostium.Afterwards, under the guidance of transthoracical or transesophageal echoeardiography, the satisfiable position forthe oceluderwas confirmed by repeated testingwith the protect string. After that, the right atrial and the oecluderwere sutured by aneedle thread for fixation.Results Of the patients, the procedurewas successfully completed in 65 cases. Themean operation timewas 38 to 95 minutes （mean, 46 minutes）. The patientswere discharged from ourhospital in 3 to 8 days. No dislocation of the deviceor atrial shutwas 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, minimallyinvasive, and convenientprocedure for ASD