不同微创技术在继发孔房间隔缺损治疗中的应用

Application of different minimally invasive techniques in treatment of secundum atrial septal defect

目的对比不同微创技术在继发孔房间隔缺损治疗中的应用结果,分析其优缺点,探讨最佳手术适应证。方法 2005年1月到2010年11月我院采用微创技术治疗继发孔房间隔缺损患者140例,年龄0.3～50岁,其中经皮导管封堵术60例,非体外循环下经胸封堵术30例,常温体外循环心脏不停跳腋下小切口修补术50例。观察和比较三种微创技术治疗房间隔缺损的手术成功率、切口长度、费用等。结果经皮导管封堵术、非体外循环下经胸封堵术、腋下小切口修补术的成功率分别为95、96.7及100,三组间无显著差别(P>0.05),无住院死亡。三组手术切口长度分别为(0.25±0.06)cm、(4.53±1.32)cm和(10.43±2.57)cm,差异有统计学意义(P<0.01);手术费用分别为(24146±3073)元,(24811±3255)元,(23300±4799)元,差异无统计学意义(P>0.05)。结论三种手术方式均是继发孔型房间隔缺损安全有效和小创伤的治疗方法。

Objective To compare the application of different minimally invasive techniques in the treatment of secundum atrial septal defect（ASD）,analyze the advantages and disadvantages,and investigate the optimal indications of the techniques.Methods Among the patients of ASD（n=140,0.3~50 years old） treated with minimally invasive techniques in our hospital from Jan.2005 to Nov.2010,60 cases were treated with percutaneous transcatheter closure,30 with non-extracorporeal circulation transthoracic closure,and 50 with off-pump subaxillary mini-incision atrioseptopexy with normothermia and extracorporeal circulation.The success rate,length of incision and operation cost of 3 minimally invasive techniques were observed and compared.Results The success rate of percutaneous transcatheter closure,transthoracic closure of non-extracorporeal circulation or subaxillary mini-incision atrioseptopexy was,respectively,95.0%,96.7% and 100.0% and the difference was not significant（P0.05）.There was no in-hospital death.The length of incision was,respectively,（0.25±0.06） cm,（4.53±1.32） cm and（10.43±2.57） cm and the difference was statistically significant（P0.01）.The operation cost was,respectively,（24 146±3073） yuan,（24 811±3255） yuan and（23 300±4799） yuan and the difference was not statistically significant（P0.05）.Conclusion The above montioned three minimally invasive techniques are safe and effective with smaller injury.