经胸小切口封堵治疗成人动脉导管未闭的对比研究

Mini-incision Transthoracic Occlusion for PDA in Adults

目的评价经胸小切口介入封堵术治疗成人动脉导管未闭的临床疗效和安全性。方法2005年11月～2007年5月,食管超声引导下完成10例经胸小切口介入封堵术(封堵组)。左胸骨旁第2肋间3～5cm切口暴露主肺动脉,缝2个荷包,将输送装置刺入肺动脉,在超声引导下经动脉导管送入主动脉,释放大于动脉导管直径4～6mm封堵器。选择2002年1月～2005年11月的20例成人体外循环动脉导管未闭手术(体外循环组)与经胸小切口介入封堵术治疗动脉导管未闭比较。结果与体外循环组相比,封堵组切口小[(3.6±1.6)cmvs(25.3±5.4)cm,t′=-16.575,P<0.05),输血少[0%(0/10)vs75%(15/20),P=0.000);手术时间短[(0.8±0.2)hvs(3.5±0.4)h,t′=-27.951,P<0.05],辅助呼吸时间短[(1.2±0.5)hvs(19.6±3.6)h,t′=-22.429,P<0.05],ICU住院时间短[(22.6±6.8)hvs(50.6±11.2)h,t=7.230,P=0.000]。结论经胸小切口介入封堵术易于操作,疗效确切,安全可靠。

Objective To evaluate the efficacy and safety of mini-incision transthoracic occlusion for patent ductus arteriosus （PDA） in adults. Methods From November 2005 to May 2007, 10 adult patients （occlusion group） received mini-incision transthoracic occlusion of PDA under the guidance of transesophageal ultrasonography in our hospital. A 3- to 5-cm incision was made at the second intercostal space adjacent to the left sternum to expose the pulmonary aorta. Afterwards, a catheter was introduced into the pulnonary artery, and then delivered into the aorta via the PDA under the guidance of uhrosonograohpy. An occluder of 4 to 6 mm larger than the PDA in diameter was then released to engage on the defect. Twenty patients who recieved on-pump surgery were set as a control group. Results Compared with the control, patients in the occlusion group had a smaller incision [ （ 3.6 ± 1.6 ） cm vs （25.3±5.4） cm, t＇= -16.575,P〈0.05], less blood transfusion [0% （0/10） vs75% （15/20）, P=0.000], and shorter operation time [（0.8 ±0.2） h vs （3.5 ±0.4） h, t＇= -27.951, P〈0.05], mechanical ventilation [（1.2 ±0.5） h vs （19.6 ± 3.6） h, t＇= -22.429, P〈0.05], andICU stay [（22.6±6.8） h vs （50.6 ±11.2） h, t=7.230, P=0.000]. Conclusion Mini-incision transthoracic occlusion is safe, reliable, and easy to handle for PDA.