经右腋下小切口外科封堵继发孔型房间隔缺损的手术体会

【摘要】目的 总结经右腋下小切口封堵治疗继发孔型房间隔缺损（ASD）的手术经验，探讨其疗效、适应证及技术要点。 方法 回顾性分析自2013年1月至2016年12月在中山大学附属江门市中心医院采用右腋下小切口行继发孔型房间隔缺损封堵的36例患者的临床资料，其中男21例、女15例，缺损大小5～36mm。所有手术均在全身麻醉、气管插管下进行。患者取左侧卧位，在腋中线与腋前线之间做直切口，长度约2～4cm，约经第4肋间进胸，切开并悬吊心包，于右心房壁缝双荷包线并切开，通过输送导管在食管超声监视下释放房间隔缺损封堵伞。结果 全组无手术死亡；术中无恶性心律失常和气栓发生，术后无脑部并发症，1例封堵伞脱落至右房，经原切口改行体外循环下手术、1例术后有2mm残余分流，术后3个月随访残余分流消失。结论 经右腋下小切口外科封堵是一种治疗继发孔型房间隔缺损的有效手术方式，具有安全可靠、简便、创伤小及术后恢复快等优点，值得临床推广。

Surgical experience of surgical closure of secondary atrial septal defect by right subaxillary incision

Abstract] Objective To summarize the experience in the treatment of secondary atrial septal defect (ASD) with small incision by right subaxillary incision, and to discuss its curative effect, indications and technical points.Methods Methods from January 2013 to December 2016, the clinical data of 36 patients with secundum atrial septal defect were analyzed by right subaxillary small incision in Jiangmen Central Hospital affiliated to Zhongshan University, including 21 males and 15 females. The size of defects was 5 to 36mm. All operations were performed under general anesthesia and tracheal intubation. In the left lateral position, do straight incision between axillary midline and the anterior axillary line, the length is about 2 ~ 4cm, with about fourth intercostal incision and pericardial suspension, in right atrial wall double purse line and cut through the conduit in esophageal ultrasonic monitoring of atrial septal defect occluder release.Results No operative death occurred. No malignant arrhythmia and gas embolism occurred during the operation. There were no complications after operation. 1 cases were treated with cardiopulmonary bypass, and 1 cases had 2mm residual shunt after operation. The residual shunt disappeared after 3 months follow-up.Conclusion Surgical closure through the right subaxillary small incision is an effective surgical procedure for the treatment of secundum atrial septal defect. It is safe, reliable, simple, minimally invasive and quick to recover. It is worthy of clinical promotion.