刘启龙+文平+卢绪宁+朱全伟

[摘要] 目的 总结食管超声引导下非体外循环经胸微创封堵先天性心脏病的临床应用经验。 方法 选择2011年11月～2013年5月食管超声引导下经胸微创封堵房间隔缺损（ASD）、室间隔缺损（VSD）患者65例，其中ASD 18例，VSD 47例。对术前、术中及术后情况进行回顾性分析。 结果 无手术死亡。中转体外5例。封堵成功患儿均于术后4 h内撤离呼吸机，监护室滞留1 d，术后3～5 d出院。复查心脏超声仅1例膜周VSD有轻微残余分流，随诊观察6个月后自行闭合。余患儿均无残余分流。1例术后心包积液，行心包穿刺后痊愈。1例患儿术中发生Ⅲ度房室传导阻滞，术后3 d恢复。全部病例均无溶血发生。 结论 食管超声引导下经胸微创封堵治疗先天性心脏病无需体外循环及输血，操作简单，安全可靠，值得推广。食管超声对缺损结构的准确反映和正确引导是手术成功的关键。

[关键词] 先天性心脏病；经胸微创封堵；食管超声

[中图分类号] R725.4[文献标识码] A[文章编号] 1674-4721（2014）03（c）-0043-03

Clinical application analysis of transesophageal echocardiography guidance minimally invasive transthoracic closure for treating congenital heart disease

LIU Qi-long WEN Ping LU Xu-ning ZHU Quan-wei

Department of Cardiothoracic Surgery,Children′s Hospital of Dalian City,Dalian 116012,China

[Abstract] Objective To summarize the clinical experience of minimally invasive transthoracic closure for treating congenital heart disease without cardiopulmonary bypass under transesophageal echocardiography.Methods A total of 65 cases of patients with atrial septal defect (ASD) and ventricular septal defect (VSD) were selected to receive transthoracic minimally invasive device closure guidanced transesophageal echocardiography in our hospital from November 2011 to May 2013,including eighteen cases of ASD and forty-seven cases of VSD.The conditions of preoperative,intraoperative and postoperative patients were reviewed.Results There was no death.Five patients were changed to cardiopulmonary bypass during the operation.Among the successful transthoracic closure of the patients,all of them were weaned from the ventilator in four hours postoperative,stayed in ICU for one day,and discharged 3 to 5 days after operation.One patient with perimembranous VSD by reviewing echocardiography had a tiny residual shunt,and then closed spontaneously after the following up six months later,others had no residual shunt.One patient after operation had pericardial effusion,and then recoverd through pericardium puncture.One patient occurred Ⅲ degree atrioventricular block,and then recoverd in 3 days after operation.All cases had no hemolysis.Conclusion Transesophageal echocardiography guidance minimally invasive transthoracic closure for treating congenital heart disease without cardiopulmonary bypass or blood transfusion is simple,safe,reliable and the technology is worth popularizing widely.Transesophageal echocardiography who can accurately reflect the defect structure and correct guidance is the key to successful operation.

[Key words] Congenital heart disease;Transesophageal echocardiography;Minimally invasive transthoracic closure

先天性心脏病发病率高达1%，严重危害儿童健康。既往先天性心脏病多采用体外循环手术治疗，部分病例可以在心导管下行介入治疗。但两者的损伤较大，难以满足临床安全、微创的要求。随着镶嵌技术的发展，内、外科技术的结合，食管超声引导下经胸微创封堵手术逐渐替代以上两种方法，成为治疗大多数先天性心脏病的首选。本文探讨食管超声引导下经胸微创封堵术治疗先天性心脏病的临床应用。

1 资料与方法

1.1 一般资料

选择本……