经胸微创室间隔缺损封堵术50例疗效分析

Evaluation of minimally invasive perventricular ventricular septal defect closure for 50 cases

目的:初步总结经胸微创室间隔缺损(ventricular septal defect,VSD)封堵术临床经验和近期疗效。方法:50例诊断明确的单纯VSD患者,气管插管全身麻醉后,经胸壁切口进入心包腔,于右心室表面合适位置缝置荷包并切开,在食管超声监测下,采用中空探条辅助或直接输送法将封堵器安放在VSD部位,若无异常情况即可释放封堵器。结果:49例封堵成功,1例术中改为常规体外循环手术。封堵成功者中,选用对称伞46例,偏心伞3例。3例发生新的微量至轻度三尖瓣反流,3例术后发生不完全右束支传导阻滞,1例术后拔除心包引流管后残存心包积液,经心包穿刺后痊愈。49例患者围术期及近期随访无死亡、无完全性房室传导阻滞、无残余分流发生、无新发主动脉瓣关闭不全。结论:经胸微创VSD封堵术具有手术创伤小,安全性高等优点,近期疗效好,远期疗效尚需进一步观察。

Objective： The paper preliminarily summarizes the clinical experience and short term effects in the chest puncture of minimally invasive treatment with ventricular septal defect（VSD） occlusion. Methods： 50 definitely diagnosed patients with VSD are cut from chest into the pericardial cavity under the condition of endotracheal intubations and general anesthesia. Jointing the purse-string and catting in the suitable position on the surface of the ventriculus dexter. Under the supervision of transesophageal eehocardiography, applying the methods of hollow bougie auxiliary and direct transportation to settle the occluder to the VSD part, and releasing the occluder without exception. Results ： The procedure was completed successfully in 49 cases and converted to traditional surgical closure with cardiopulmonary bypass in 1 case. Concentric devices were used in 46 cases and encentric devices were used in 3 cases. During the perioperative and short-term follow-up period, there is no death, no complete atrioventricular block, no residual shunt and no new aortic valve insufficiency of the 49 cases. Conclusion：The chest punctures of minimally invasive treatment with VSD occlusion have advantages of fe wer traumas, and high security. This kind of therapy has good short-term effects with long-term effects to be further observed.