非体外循环小切口房间隔缺损封堵术的应用

Clinical application of minimal invasive closure of atrial septal defect without cardiopulmonary bypass

目的介绍及推广一种闭合房间隔缺损的小切口非体外循环手术方法。方法2004年9月至2007年4月我院收治房间隔缺损患儿46例（男22例，女24例）；年龄8个月～16岁，其中8个月～1岁共11例，1～5岁共18例，5岁以上17例，体重8．5～35kg．房间隔缺损直径8～25mm，均为继发孔中央型。全组均在全麻下经右胸壁第四肋间小切口入胸，通过食管超声术中监测各切面房间隔大小及边缘情况，选择相应大小封堵器并经右房置入封堵器，行推拉试验确认牢固后释放封堵器。结果45例房间隔缺损患儿封堵成功，1例失败。房间隔缺损直径8～25mm，房间隔各边缘最短分别距二尖瓣瓣根部7mm、距左房顶8mm、距上腔静脉6mm、距下腔静脉6mm。术后房间隔水平无分流，无明显手术并发症。结论经右胸小切口非体外循环下房间隔缺损封堵术损伤小、无辐射、操作简单、安全性高，具有临床应用价值。

Objective To apply a surgical approach of minimal invasive closure to atrial septal defect （ASD） without cardiopulmonary bypass. Methods Between Sept. 2004 and Apr. 2007, 46 cases （male 22, female 24） of atrial septal defect （ASD） were treated by minimal invasive closure without cardiopulmonary bypass, Their age ranged from 8mon to 16yr （mean 4. 7 ± 3.9 yr） and weight ranged from 8. 5 to 35 kg. （mean 15.2 ± 6. 5 kg）. The incision was through the right 4th intercostals space after general anesthesia, and the character and size of ASD were confirmed via the transesophageal echocardiography （TEE）. The occluder device suitable to the ASD was placed through the right atrium and released after making sure its firmly in place of the defect. Results Among them, 45 cases of ostium secundum ASD were closed successfully and I failure. The size of ASD was from 8 mm to 25 ram, and the shortest distance of the rim of ASD was 7 mm to the mitral valve, 8 mm to the top of left atrium, 6 mm to superior vena cava and 6 mm to inferior vena cava. There were no residual shunts and operative complications. Conclusions The advantages of minimally invasive closure of ASD without cardiopulmonary bypass are less traumas, no radiation, easy and security of manipulation. It is valuable for clinical application.