目的：探讨左腋下途径外科微创封堵高位室间隔缺损（ ventricular septal defect，VSD）的可行性、安全性和优势。方法2014年6～8月，采用左腋下途径外科微创封堵高位VSD 15例。全麻，放置食道超声探头，再次评估和筛选后，做左腋下直切口3～4 cm，第3肋间入胸，根据超声选择合适的封堵器，经食道超声心动图（ transesophageal echocardiography，TEE）引导下置入封堵器关闭VSD，实时监测封堵器的位置，有无残余分流，是否累及主动脉瓣、肺动脉瓣，是否有心律失常等。结果15例封堵均成功。1例首次安放封堵器后残余分流，更换大一号封堵器后封堵成功。1例首次安放对称封堵器后主动脉瓣反流，更换偏心型室缺封堵器后封堵成功。术后5～9天痊愈出院。均随访3个月，无封堵器脱落、残余分流、新增瓣膜反流、心包积液、心内感染、心律失常和溶血等严重并发症。结论左腋下途径外科微创封堵高位室间隔缺损创伤小，术后渗出少，瘢痕小，切口隐蔽，是极具推广价值的创新手术。%Objective To explore the feasibility, safety, and advantages of left armpit approach minimally invasive plugging for high ventricular septal defect (VSD). Methods From June to August of 2014, left armpit approach minimally invasive plugging was applied to 15 cases of ventricular septal defect.Ultrasonic probe was placed into the esophagus after the success of the general anesthesia.After confirmative evaluation and selection, a left armpit incision 3-4 cm in length was made for entering the chest at the third intercostal space.According to ultrasonic results, appropriate occluder was selected to implant and close VSD under the guidance of transesophageal echocardiography.Real-time monitoring of the location of the occluder was performed to clarify residual shunt, aortic valves, pulmonary valves, and arrhythmia. Results All the 15 patients were successfully occluded.Residual shunt was found in 1 case after occluder placement, requiring a bigger sized block.Aortic regurgitation was seen in 1 case after the placement of a symmetric occluder, and a dissymmetric occluder was used to replace the one.The patients were recovered 5-9 days after treatment.Follow-up reviews for 3 months found no occluder displacement, residual shunt, valvular regurgitation, pericardial effusion, infection, arrhythmia, or hematolysis. Conclusion Left armpit approach surgical plugging for ventricular septal defect is a kind of new minimally invasive method, with advantages of small surgical trauma, less postoperative leakage, and small and hidden incision, being worthy of promotion.
展开▼
