全胸腔镜下房间隔缺损封堵术186例报告

发布时间：2018-03-05 11:01

  本文选题：房间隔缺损　切入点：封堵术　出处：《中国微创外科杂志》2017年10期 　论文类型：期刊论文

【摘要】：目的探讨全胸腔镜非体外循环下房间隔缺损微创封堵术治疗先天性继发孔房间隔缺损(atrial septal defect,ASD)的疗效。方法 2008年5月~2016年5月186例先天性继发孔ASD行全胸腔镜非体外循环下房间隔缺损微创封堵术。全麻,右侧第7肋间腋中线1.0 cm小孔置入胸腔镜,右侧锁骨中线微切口2.0 cm,第4肋间进胸,作为操作孔。术中经食道超声(TEE)引导下经输送器置入封堵器闭合ASD。结果 178例成功封堵,7例中转胸腔镜辅助体外循环下修补术(2例上腔型、3例下腔型、2例中央型由于房间隔缺损过大,封堵器影响二尖瓣结构),1例次日心脏彩超发现封堵器脱落立即送手术室行开胸体外循环下直视修补术。无死亡,术中出现室上性心动过速6例,Ⅲ度房室传导阻滞3例,经治疗均转为窦性心律;胸腔积液5例,经引流等治疗痊愈。术后3~7 d出院。178例随访0.5~8年,(3.2±1.9)年,彩超示封堵器无残余漏、移位,心功能Ⅰ级70例,Ⅱ级83例,Ⅲ级25例。结论全胸腔镜下房间隔缺损封堵术采用微切口入路,符合美容要求,无须体外循环,费用低,术后恢复快,临床效果确切,若封堵不成功,可同期直接改体外循环下直视修补术。
[Abstract]:Objective to evaluate the efficacy of total thoracoscopic minimally invasive closure of atrial septal defect (ASD) in the treatment of congenital atrial septal defect (ASD). Methods from May 2008 to May 2016, 186 patients with congenital secondary atrial septal defect (ASD) underwent total thoracoscopic non-invasive closure of atrial septal defect (ASD). Minimally invasive closure of atrial septal defect under cardiopulmonary bypass. The right seventh intercostal axillary midline 1.0 cm hole was inserted into thoracoscope, the right central clavicular line microincision was 2.0 cm, and the 4th intercostal cavity was inserted into thoracic cavity. ASD was closed by transcatheter occluder under the guidance of transesophageal ultrasound (TEE) during operation. Results the successful closure of ASD was achieved in 7 cases of 7 cases of transcatheter closure under thoracoscopic assisted cardiopulmonary bypass repair of 2 cases of superior cavity type and 3 cases of inferior cavity type 2 cases of central type. Because the atrial septal defect is too large, The occluder affected the mitral valve structure in 1 case. The next day, color Doppler echocardiography found that the occluder was removed and sent to the operating room immediately for direct vision repair under cardiopulmonary bypass. There was no death, there were 6 cases of supraventricular tachycardia and 3 cases of 鈪，

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