摘要
目的总结单纯超声引导经皮穿刺封堵治疗继发孔中央型房间隔缺损的临床经验,并评价其安全性和疗效。方法 23例继发孔中央型房间隔缺损患者,均接受单纯超声引导经皮穿刺封堵治疗,采用局麻或全麻,单纯经胸或经食道超声引导,经股静脉或颈内静脉穿刺植入可调弯鞘管,选择国产先健封堵器封堵房间隔缺损,超声监测封堵全过程,评估封堵效果。结果全组20例经外周静脉穿刺封堵成功,其中经股静脉18例,经颈内静脉2例;3例经外周静脉穿刺封堵困难或失败,改为经胸小切口封堵成功。单纯经胸超声引导2例,单纯经食道超声或联合经胸超声引导21例。手术时间20～75(41. 39±13. 77) min,植入封堵器型号12～40(22. 52±8. 05) mm。全部患者住院期间无死亡,无残余分流,无心律失常、溶血及心内感染,无外周静脉损伤及栓塞。术后住院时间2～4(2. 74±0. 69)d,术后随访2～8(4. 70±2. 20)个月,所有患者无残余分流,无封堵器脱落、移位,无心包积液,右心房室不同程度缩小,合并的三尖瓣返流消失或减轻。结论超声引导经股静脉或颈内静脉穿刺封堵房间隔缺损是一种操作简单、创伤轻微、并发症少、安全有效的术式。
Objective To summarize the clinical experience of percutaneous occlusion for treating atrial septal defect under echocardiographic guidance alone, and to evaluate its safety and efficacy.Methods Twenty-three patients with ostium secundum atrial septal defect received percutaneous occlusion under echocardiographic guidance alone. Local or general anesthesia was performed,then a deflectable sheathing catheter was inserted by femoral vein or internal jugular vein puncture under transthoracic or transesophageal echocardiographic guidance alone. Occlusion of atrial septal defect was conducted using domestically-made occluder of Lifetech Scientific Corporation. The echocardiography was used to monitor the whole process of occlusion and assess the efficacy of occlusion. Results Of all cases, peripheral venipuncture and occlusion was successfully completed in 20 cases including 18 cases through femoral vein and2 cases through internal jugular vein. Difficulty in or failure in peripheral venipuncture and occlusion was occurred in 3 cases,and conversion to mini-incision transthoracicvenipuncture was successfully completed in those cases. Two cases were guided by transthoracic echocardiography alone,and 21 cases were guided by transesophageal echocardiography alone or combined with transthoracic echocardiography. The duration of operation was 20 to 75(41. 39 ± 13. 77) min,and the specification of inserted occluder was 12 to 40(22. 52 ± 8. 05) mm. No death,residual shunt,arrhythmia,hemolysis,intracardiac infection,peripheral vein injury and embolism occurred in any patients during hospitalization. The postoperative hospital stay was(2. 74 ± 0. 69) days. The duration of postoperative follow-up was 2 to 8(4. 70 ± 2. 20)months,no residual shunt,detachment or replacementof occluder,pericardial effusion occurred in any patients. The right atrium and right ventricle werereduced to varying degrees,and the previous complication of tricuspid regurgitationdisappeared or was alleviated. Conclusion Echocardiography guided occlusion
作者
刘胜中
向波
蒋露
谭今
魏大闯
刘科
曾富春
于涛
黄克力
左明良
LIU Shengzhong;XIANG Bo;JIANG Lu;TAN Jin;WEI Dachuang;LIU Ke;ZENG Fuchun;YU Tao;HUANG Keli;ZUO Mingliang(Cardiac Surgery Center,Sichuan Academy of Medical Sciences &the People's Hospital of Sichuan Provincial,Chengdu,Sichuan 610072,China;Department of Cardiovascular Ultrasound and Cardiac function,Sichuan Academy of Medical Sciences &the People's Hospital of Sichuan Provincial,Chengdu,Sichuan 610072,China)
出处
《微创医学》
2018年第6期712-716,共5页
Journal of Minimally Invasive Medicine
基金
四川省卫生厅科研课题(编号:110222)
关键词
房间隔缺损
超声心动图
封堵术
股静脉
颈内静脉
Atrial septal defect
Echocardiography
Occlusion
Femoral vein
Internal jugular vein
