中国医药
中國醫藥
중국의약
CHINA MEDICINE
2010年
7期
598-599
,共2页
郑铁%郭可泉%王坚刚%孟旭
鄭鐵%郭可泉%王堅剛%孟旭
정철%곽가천%왕견강%맹욱
房间隔缺损%微创经胸小切口%封堵术%心外科修补手术
房間隔缺損%微創經胸小切口%封堵術%心外科脩補手術
방간격결손%미창경흉소절구%봉도술%심외과수보수술
Atrial septal defect%Minimally invasive intercostal incision%Occlusion therapy%Cardiac surgical closure
目的 探讨微创非体外循环下经胸小切口继发孔房间隔缺损(ASD)封堵术失败后转外科修补手术的治疗方法及临床疗效.方法 2008年1月至2008年12月,我院行微创非体外循环下经胸小切口继发孔ASD封堵术268例,其中封堵术失败后需再行外科修补手术者12例,包括术中封堵器脱落6例,术中封堵失败3例,术后封堵器脱落1例,Ⅲ度房室传导阻滞1例,残余漏1例.外科修补手术于体外循环下进行,取出封堵器,修复缺损.结果 外科修补手术探查继发孔ASD直径平均为(28.6±6.2)mm,大于术前经食管超声心动图测量的值[(24.3±4.1)mm,P＜0.01].术中探查证实,6例术中封堵器脱落患者缺损为下腔型4例、中央型2例;术后1例封堵器脱落患者缺损为中央型;术中3例封堵失败患者中筛孔状缺损1例,下腔型2例;Ⅲ度房室传导阻滞1例为中央型;1例残余漏患者缺损为中央型,但边缘菲薄.外科修补术后所有患者均恢复窦性心律,无手术死亡,无残余分流.结论 微创非体外循环下经胸小切口继发孔ASD封堵术失败后应及时采取外科修复手术治疗,这样可有效治疗封堵术失败后的并发症.而这种急诊手术并没有增加患者的病死率和严重并发症的发生率,所以可以对患者先尝试封堵,不成功再行外科修补手术.
目的 探討微創非體外循環下經胸小切口繼髮孔房間隔缺損(ASD)封堵術失敗後轉外科脩補手術的治療方法及臨床療效.方法 2008年1月至2008年12月,我院行微創非體外循環下經胸小切口繼髮孔ASD封堵術268例,其中封堵術失敗後需再行外科脩補手術者12例,包括術中封堵器脫落6例,術中封堵失敗3例,術後封堵器脫落1例,Ⅲ度房室傳導阻滯1例,殘餘漏1例.外科脩補手術于體外循環下進行,取齣封堵器,脩複缺損.結果 外科脩補手術探查繼髮孔ASD直徑平均為(28.6±6.2)mm,大于術前經食管超聲心動圖測量的值[(24.3±4.1)mm,P＜0.01].術中探查證實,6例術中封堵器脫落患者缺損為下腔型4例、中央型2例;術後1例封堵器脫落患者缺損為中央型;術中3例封堵失敗患者中篩孔狀缺損1例,下腔型2例;Ⅲ度房室傳導阻滯1例為中央型;1例殘餘漏患者缺損為中央型,但邊緣菲薄.外科脩補術後所有患者均恢複竇性心律,無手術死亡,無殘餘分流.結論 微創非體外循環下經胸小切口繼髮孔ASD封堵術失敗後應及時採取外科脩複手術治療,這樣可有效治療封堵術失敗後的併髮癥.而這種急診手術併沒有增加患者的病死率和嚴重併髮癥的髮生率,所以可以對患者先嘗試封堵,不成功再行外科脩補手術.
목적 탐토미창비체외순배하경흉소절구계발공방간격결손(ASD)봉도술실패후전외과수보수술적치료방법급림상료효.방법 2008년1월지2008년12월,아원행미창비체외순배하경흉소절구계발공ASD봉도술268례,기중봉도술실패후수재행외과수보수술자12례,포괄술중봉도기탈락6례,술중봉도실패3례,술후봉도기탈락1례,Ⅲ도방실전도조체1례,잔여루1례.외과수보수술우체외순배하진행,취출봉도기,수복결손.결과 외과수보수술탐사계발공ASD직경평균위(28.6±6.2)mm,대우술전경식관초성심동도측량적치[(24.3±4.1)mm,P＜0.01].술중탐사증실,6례술중봉도기탈락환자결손위하강형4례、중앙형2례;술후1례봉도기탈락환자결손위중앙형;술중3례봉도실패환자중사공상결손1례,하강형2례;Ⅲ도방실전도조체1례위중앙형;1례잔여루환자결손위중앙형,단변연비박.외과수보술후소유환자균회복두성심률,무수술사망,무잔여분류.결론 미창비체외순배하경흉소절구계발공ASD봉도술실패후응급시채취외과수복수술치료,저양가유효치료봉도술실패후적병발증.이저충급진수술병몰유증가환자적병사솔화엄중병발증적발생솔,소이가이대환자선상시봉도,불성공재행외과수보수술.
Objective To assess the therapeutic methods and results of surgical closure of atrial septal defect (ASD) after the failure of occlusion therapy via non-cardiopulmonary bypass (CPB)-minimally invasive intercostal incision (MⅢ). Methods From January 2008 to December 2008, twelve patients from 268 patients underwent occlusion therapy via non-CPB- MⅢ, were performed surgical closure of ASD after the failure of occusion. The causes accounting for the transition consist of introoperative or postoperative dislodgment of occusion device in 6 cases and 1 case respectively, infeasibility in 3 cases, Ⅲ °atrio-ventricular block (AVB) in 1 case and residual shunt in 1 case. All patients underwent the removal of occlusion device and surgical closure of ASD. Results The mean stretched diameter of the ASD (28.6 ± 6.2 mm) was significantly larger ( P ＜ 0.01 ) than that measured by transesophageal echocardiography (TEE) (24.3 ±4.1 mm). The pathological type of ASD was confirmed with the inferior vena cava type in 4 cases of introoperative dislodgment of occusion device, the central tyepe in 2 cases and 1 case of introoperative or postoperative dislodgment repectively, the sieve pore type in 1 cases infeasible to occlusion, and with thin marginal tissue in 1 case with residual shunt. Sinus rhythm was postoperatively observed in all patients. No perioperative mortality and postoperative residual shunt was found. Conclusion Surgical treatment should be performed in time after the failure of occlusion to achieve a good outcome.
