房间隔缺损介入治疗和外科手术的对比分析

Contrast analysis between transcatheter and surgical closure methods in patients with atrial septal defect

目的:比较经导管封堵与外科手术治疗继发孔型房间缺损(ASD)的疗效、安全性和费用情况。方法:采用相同的入选标准,选择继发孔型ASD患者148人,其中介入治疗组82例,外科手术组66例。应用回顾性对比研究方法,比较两组的疗效、并症和费用情况。结果:介入治疗组和外科手术组的成功率分别为95.1%和100%(P=0.018),术后残分流率分别为3.5%和3.0%(P=0.833)。心律失常为最常见并发症,介入组低于外科组(14.6%∶31.8%,P<0.05);介入组中无1例患者需要输血,外科组中全部患者需要输血(P<0.001);介入组和外科组操作时间分别为(48±12.2)min和(158±16.4)min(P<0.001);介入组住院天数短于外科组[(6.0±2.0)d∶(13.0±3.0)d,P<0.01]。介入组和外科组治疗费用分别为(26729±1675)元和(22393±1739)元(P<0.05)。结论:外科手术较经导管封堵术成功率稍高、适应症广,但经导管封堵术却有手术时间短、并发症发生率低、创伤小、恢复快等优点。

Objective： To compare the safety , efficacy, complications and cost between transcatheter and surgical closure methods in patients with atrial septal defect （ASD）. Methods： Retrospective analysis was done on 148 patients with secondum atrial septal defects： 66 cases were treated surgically and 82 cases were treated by transcatheter closure. The safety , efficacy, complications and cost between two groups were compared, Results： The instant procedural success rate was 95.1% for the transcatheter closure group and 100% for the surgical closure group （P= 0. 018 ） . Total complication rates both of the transcatheter closure group and the surgical closure group were 18.3% and 34. 8 respectively （P〈0.05）, Blood products were administered to 36 patients in the surgical group and no patient in the transcatheter closure group （P〈0. 01） , Mean operation time both of the transcatheter closure group and the surgical closure group was （48±12.2） rain and （158±16.4） min （P〈0. 001 ）; days of stay in hospital were （6.0±2.0） days in transcatheter occlude group, （13.0±3.0） days in surgery group respectively, Cost both of the transcatheter closure group and the surgical closure group were RMB （26729±1675） and RMB （22393±1739） respectively （P〈0.05）. Conclusion： Transcatheter closure of secondum ASD with Amplatzer septal occluder is an efficient, non-surgical, and safe method although its success rate is lower,