经胸壁打孔房间隔缺损封堵术(附3例报告)

Closure of atrial septal defect through thoracostomy with occluder:a review of 3 cases

目的总结微创胸壁打孔房缺封堵术的手术经验。方法3例继发孔房缺病人,进行微创非体外循环房间隔缺损修补术。取胸骨右缘第4肋间进胸,切口长约2.5-3.5 cm,实时经胸壁超声监测,经右房前壁预制荷包线处插入已置入封堵器的推送套筒于右心房,经房间隔缺损入左心房,释放封堵器,推出推送导管。经胸壁超声鉴定房水平无分流,右肺静脉开口二尖瓣、三尖瓣及冠状静脉窦功能完好后,闭合房间隔缺损(ASD)。术毕经胸壁超声检测显示未见残余血流通过,逐层关闭切口。结果3例病人均一次封堵成功,术后第2天均可下床活动,3 d出院,术中及术后无并发症。随访2-3个月,术后复查超声心动图心脏较术前缩小,未见封堵器脱落、变形及残余分流,心功能良好。结论胸壁打孔房间隔缺损封堵术手术具有微创、安全、简便、高效、无X线辐射、手术适应证广、术后残余分流发生率低等优点,是一项值得推广的外科治疗新技术。

Objective To sum up surgery experience of atrial septal defect closure with occluder by minimal invasion. Methods Three patients with secondary ASD underwent the treatment with a minimally invasive closure using occluder without extracorporeal circulation. All patients were anaesthesized and a 2.5 - 3.5 cm incision was made in the 4th intercostal space of the right edge to expose the right atrium,at which a purse-string suture was placed. A double-lumen delivery catheter was then punctured into the right atrium, and passed through the defect to the left atrium under the guidance of echocardiography. An occluder made of a nickel-titanium metal alloy was released to engage on the defect. The delivery catheter was then withdrawn. Results Three patients was successfully occluded at once and got out of bed and walked around in the next day. The hospitalization duration was 3 days. No complications and occluder dislodgment occurred. Colour Doppler imaging after operation showed complete occlusion of the ASD without residual shunt. Conclusion The transthoracic closure of atrial septal defect with occluder is an efficient,safe,simple and non-radiation, and worthy of application.