标题：经食管超声心动图在左心耳封堵术中的应用价值

      作者：林瑞基，余木生，梁世玲，梁艳红    (阳江市人民医院门诊部超声科，广东 阳江 529500)

      卷次： 2018年29卷9期

      【摘要】 目的 探讨经食管超声心动图在左心耳封堵术中的应用价值。方法 选取2015年5月至2017年6月阳江市人民医院收治的拟行左心耳封堵术的房颤患者47例，术前对其进行经食管超声心动图以去除存在手术禁忌证的患者；术中采用三维经食管超声心动图引导手术进行并测量左心耳开口最大、最小直径以及最大深度，以选用合适的封堵器；术后3个月以经食管超声心动图复查。结果 47例患者中 11例因存在手术禁忌证而被排除；余36例患者左心耳共有29例(80.56%)“鸡翅”型，5例(13.89%)“仙人掌”型，2例(5.56%)“风向袋”型；术前探查显示平均左心耳开口最大直径为(22.40±3.91) mm，最小直径为(19.73±2.71) mm，深度为(26.01±5.32) mm。所有患者均成功完成手术，术中在超声心动图引导下房间隔穿刺及鞘管输送均顺利完成，并根据结果选择Watchman型封堵器，其中3例更换封堵器。术后复查封堵情况均良好，其中2例出现残余分流。结论 围左心耳封堵术可有效治疗房颤，且经食管超声心动图在其围术期及术后评估中均有较大价值，值得在临床推广使用。
      【关键词】 围左心耳封堵术；经食管超声心动图；房颤
      【中图分类号】 R654.2 【文献标识码】 A 【文章编号】 1003—6350（2018）09—1260—03

Value of transesophageal echocardiography in the treatment of percutaneous left atrial appendage transcatheterocclusion.
LIN Rui-ji, YU Mu-sheng, LIANG Shi-ling, LIANG Yan-hong. Outpatient Department of Ultrasound, thePeople's Hospital of Yangjiang City, Yangjiang 529500, Guangdong, CHINA
【Abstract】 Objective To investigate the value of transesophageal echocardiography in percutaneous left atrialappendage transcatheter occlusion. Methods Forty-seven patients with atrial fibrillation undergoing left atrial append-age transcatheter occlusion, who admitted to Yangjiang People's Hospital from May 2015 to June 2017, were selected asthe research subjects. Preoperative transesophageal echocardiography was performed to remove patients with contraindi-cations. Intraoperative three-dimensional transesophageal echocardiography guided surgery was used to measure themaximum, minimum diameter, and maximum depth of the left atrial appendage opening to choose the appropriate oc-clude. Transesophageal echocardiography was used to reexamine three months after operation. Results Of the 47 pa-tients, 11 were excluded for surgical contraindications; there were 29 cases (80.56%) of“chicken wing”type in the leftatrium of the other 36 cases, 5 cases (13.89%) of“cactus”type and 2 cases (5.56%) of“windsock”. The preoperativelyaverage diameter of the left atrial appendage was (22.40±3.91) mm, and minimum diameter was (19.73±2.71) mm, withlength of (26.01±5.32) mm. All patients successfully completed operation, intraoperative echocardiography guided atrialseptal puncture and sheath delivery were successfully completed to select Watchman occlude according to the results, ofwhich 3 cases replaced the occlude. Postoperative review occlusion was good in all the cases, of which 2 cases showedresidual shunt. Conclusion Left atrial appendage occlusion surgery can be effective in the treatment of atrial fibrilla-tion, and esophageal echocardiography in its perioperative and postoperative assessment are of great value, which isworth to be promoted in clinical practice.
      【Key words】 Percutaneous left atrial appendage transcatheter occlusion; Transesophageal echocardiography; Atri-al fibrillation·论 著·doi:10.3969/j.issn.1003-6350.2018.09.024