心房间隔缺损闭式修补术

Closed heart repair of atrial septal defect

目的 总结 2 1 8例心房间隔缺损闭式修补术的经验。方法 手术方法有三种 :埋藏内褥式、外褥式带垫片缝合和埋藏内“8”字缝合。房间隔缺损直径为 0 8～ 4 5cm ,其中 2例伴有右上肺静脉畸形引流。平均手术时间 96 7min ,1 4 9例 (6 8% )术中和术后均未输血 ,6 9例平均输血 2 83ml。结果 本组病例无死亡 ,术后随访发现房间隔撕裂再通者 4例 (2 % ) ,其余病例均恢复良好。结论 只要病例选择恰当 ,该种手术方法比体外循环心内修补法更简便、安全、经济 ,且大多数病例无需输血 ,有推广价值。但要求术者黯熟心脏解剖并具有娴熟的手术技巧。

Objective To describe a method for repairing atrial septal defect (ASD) by closed heart surgery and the analysis of 218 cases in the past 20 years.Methods From Oct.1979 to Jan.1999,two hundred and eighteen patients were operated on to repair ASD by closed heart surgery.The sizes of ASD varied from 0 8～4 5cm in diameter.There were three approaches:(1)Buried intraatrial mattress suture (205 cases);(2)Extracardial mattress suture with small pledget (10 cases);(3)Buried intraatrial 8 shaped suture (3 cases).No blood perfusion needed in 149 cases (68%) during and after the operation,and 69 patients (32%) received blood perfusion of 200～800 ml(mean 283ml).Results There was no death in or out hospital in this series.Recurrence of ASD occurred in four patients (2%),and one of them received re operation to close the defect by open heart surgery.Conclusion The closed heart repair of ASD is most suitable to those with ASD at the site of fossa ovalis and the size of 3 5cm and less in diameter.Compared with open heart repair under extracorporeal circulation,this technique is much simpler,safer and costs less,and has also less risk of HCV infection because most of the patients(69%) do not need blood perfusion both during and after operation.