张胜康++尹晓清++徐朝军++王兆礼++杨进++程宇+解鑫隆

[摘要] 目的 探讨彩超引导下经皮封堵房间隔缺损的效果及应用的局限性。 方法 选取2015年1月～2016年3月湖南中医药大学第一附属医院心胸外科46例行彩超引导下经皮封堵治疗的中央型房间隔缺损的患者，术中根据房间隔缺损的大小、位置及患者的自身情况选择经颈内静脉或经股静脉入路进行封堵。 结果 经股静脉入路封堵42例，成功41例，中转开胸封堵1例；经颈内静脉入路封堵4例，成功3例，中转开胸封堵1例；封堵成功的患者术后恢复快，术后随访均未发生封堵伞移位、残余分流、血栓及溶血等相关并发症。 结论 彩超引导下经皮中央型房间隔缺损封堵手术可能是一种取代传统封堵术的治疗方法。

[关键词] 房间隔缺损；彩超引导；微创；封堵

[中图分类号] R654.2 [文献标识码] A [文章编号] 1673-7210（2017）09（b）-0057-04

46 cases of central type atrial septal defect intervention by percutaneous closure with color Doppler ultrasound

ZHANG Shengkang YIN Xiaoqing XU Zhaojun WANG Zhaoli YANG Jin CHENG Yu XIE Xinlong

Department of Cardiothoracic Surgery， First Affiliated Hospital of Hu'nan University of Traditional Chinese Medicine， Hu'nan Province， Changsha 410000， China

[Abstract] Objective To investigate the effect and application of percutaneous transcatheter closure of atrial septal defect with color Doppler ultrasound. Methods From January 2015 to March 2016， in Department of Cardiothoracic Surgery， First Affiliated Hospital of Hu'nan University of Traditional Chinese Medicine， 46 patients with central type atrial septal defect underwent ultrasound guided percutaneous interventional therapy were selected， internal jugular vein or femoral vein was chosen as the surgical approach according to the size and location of the atrial septal defect， and the patients' own situation. Results 42 cases were blocked by femoral vein approach， 41 cases were successful， 1 case was converted into thoracic plugging. 4 cases were blocked by internal jugular vein approach， 3 cases were successful， 1 case was transferred to thoracic plugging. The 44 successful cases recovered fast with no complications such as occluder dislocation， residual shunt， thrombus， hemolysis in Postoperative followed-up. Conclusion Percutaneous closure of atrial septal defect with color Doppler ultrasound may be a new treatment method to replace the traditional method.

[Key words] Atrial septal defect； Color Doppler ultrasound guidance； Minimally invasive； Occlusion

房間隔缺损是一种常见的先天性心脏病，其手术治疗方法多样，包括传统的正中开胸或右侧开胸直视修补术、X线引导下的经皮封堵术及彩超引导下的经胸小切口封堵术等。传统手术需体外循环辅助，创伤大；经胸小切口房间隔缺损封堵术术后仍留有3 cm左右的手术瘢痕，特别是女性患儿，有可能影响乳房发育，且开胸后易并发肺部感染、液气胸等并发症X线引导下经皮房间隔缺损封堵术全程需要X线透视引导，有可能对患者及医护人员造成潜在的辐射损伤[1-2]，近几年发展起来的彩超引导下经皮房间隔缺损封堵术很好的解决了以上问题。……