经导管室间隔缺损封堵术与外科手术治疗膜周部室间隔缺损的对比研究

Comparative study on treatment of perimembranous ventricular septal defects by transcatheter closure of VSD and by surgical repair

目的 分析比较经导管室间隔缺损封堵术 (TCVSD)与外科修补术治疗膜周部室间隔缺损的疗效及优缺点 ,为临床提供优选依据。方法 外科组包括接受外科手术治疗的 4 5例膜周部室间隔缺损 (VSD)患者 ,采用直接缝合或补片修补VSD ;TCVSD组包括同期接受TCVSD术的 4 5例膜周部VSD患者 ,采用新型偏心状Amplatzer膜周部室间隔缺损封堵器封堵VSD。比较两组的疗效、并发症和费用等情况。结果 TCVSD组 4 4例封堵成功 (技术成功率 98% ) ,术后出现少量残余分流3例 (均小于 2mm) ,出现完全性左束支传导阻滞 1例 ,无其他严重并发症发生 ;外科手术组全部手术成功 ,无死亡 ,术后出现残余分流 1例 (3～ 4mm) ,心包积液 1例 (后行切开引流术 ) ,切口内出血 1例(后行二次缝合术 ) ,左前分支阻滞 2例。两组间治疗前后左室舒张末径 (LVEDD)的减小程度无明显差异 (P >0 0 5 ) ,总住院天数及特护天数TCVSD组要明显少于外科组 ,治疗总费用及器材费TCVSD组要明显高于外科组。结论 TCVSD术疗效与外科手术相当 ,具有并发症较少 ,术后恢复快 ,不留疤痕等优点 ,但治疗费用较高 ;对于部分选择性病例 ,TCVSD术可以逐步替代外科手术成为治疗膜周部VSD的首选方法。

Objective To compare the effectivity and cost of transcatheter cloure of ventricular defects(TCVSD) and surgical repair of VSD on treatment of perimembranous VSD. Methods The surgery group included 45 patients (21 males,24 females) with primembranous VSD underwent surgical repair with or without dacron patch. The TCVSD group included forty-five patients (22 males,23 females) with primembranous VSD underwent TCVSD using the new Amplatzer membranous VSD occluder during the same period. The effectivity, complications and cost of both methods were compared. Results The technical success rate of the TCVSD group was 98%. Mild residual shunt occured in three patients after closure and didn't disappear at the follow-up of 3 months. Complete left bundle branch block (LBBB) was seen in one patient and existed at the follow-up of 1 years. There were no other severe complications in the TCVSD group.All the operation were successful in the surgery group with no death, a little residual shunt occured in one patient after surgical repair. The major complications in the surgery group included: effusion of pericardium in 1 patient, staxis of wounds needing a second operation in 1 patient, left anterior bundle branch block in 2 patients. The decrease of left ventricle end-diastolic dimension (LVEDD) of both groups had no significant difference ( P >0.05). The total in-hospital days and the ICU days in the TCVSD group was much less than those in the surgery group, and the total cost and the material cost of the TCVSD group were much higher than those of the surgery group. Conclusion For most of the selective patients with perimembranous VSD, the TCVSD would be the first selection instead of surgical repair step by step.