复合技术治疗低龄低体重病儿房间隔缺损

New hybrid procedure for closure of a atrial septal defect

目的介绍一种房间隔缺损（ASD）“复合”技术介入封堵方法，并探讨该手术方法的优缺点。方法2007年6月至2008年3月，27例婴幼儿房间隔缺损者接受新“复合”技术治疗。其中男15例，女12例。年龄3个月～4岁，平均（2．00±0．22）岁。采用浅镇静加局部麻醉，非气管插管单纯面罩吸氧或喉罩下辅助通气支持，胸骨旁第4肋间小切口，保留胸膜，经胸膜外进入心包腔显露右心房壁，切开右房壁置入ASD封堵器及输送器。心前区或剑突下超声引导进行ASD介入封堵术。结果全部病儿3d后康复出院，随访0．5～9．5个月，平均（5．9±0．5）个月，仅1例病儿因心包压塞行心包穿刺引流术，余无异常。超声检查没有残余分流或其它并发症。结论该手术方法创伤小、疗效好，费用低，是婴幼儿ASD病例一种较为理想手术方法。

Objective To describe a new hybrid procedure for closure of a atrial septal defect （ASD）. The aim of our study was to demonstrate the conceptual development and the feasibility of a hybrid approach to closure of ASD. Methods June 2007 to March 2008, 27 ASD infant patients （ 15 male, 12 female）underwent a new hybrid procedure treatment in Fuwai Hospital. The age of patients from 3 months to 4-year-old [ mean age （2.（30 ± 0.22） years old ]. On the condition of conscious analgesia/sedation with remifentanil and propofol （while local anesthesia with ropivacaine）, the patients keep spontaneous respiration by facemask or laryngeal airway mask with 40% -60% oxygen and 1% - 2% sevoflurane. A minimal right parastemal incision through the fourth intercostals space was used to cut open the fourth intercostals muscle to pericardial cavity. Keeping plcural membrane integrity and through ectal pleural membrane access, right atrium was be exposed. The atrial septal oceluder device and delivery system was being sent into right atrium through right atrium incision. The atrial scptal occluder was deployed and evaluated under intraoperative precordium or xiphoid process ochocardiography guidance. Results All infant patients recovered uneventfully and discharged from hospital three days after operation. Patient follow-up occurred from 0.5 to 9.5 months [ mean of （5.9 ± 0.5） months ]. All patients were free of symptoms and postoperation complications during follow-up, only one patient was been paraeentesis pericardii for pericardial tanrponade. Conclusion This new hybrid procedure is effective and safe. The cost of this new procedure is lower than other treatments. It is an ideal treatment to infant atrial scptal defect patients.