经胸微创封堵术与体外循环下手术治疗室间隔缺损效果的比较

Efficacy comparison between micro invasive occlusion procedure and extracorporeal circulation procedure for treating patients with simple ventricular septal defect

目的比较经胸微创封堵术与体外循环下外科治疗除干下型室间隔缺损以外的单纯室间隔缺损的效果。方法入选经超声心动图确诊为单纯室间隔缺损（非干下型）的患者220例。将患者分为两组，微创组（116例）采用经胸微创封堵术治疗，手术组（104例）采用传统的体外循环下手术治疗。收集患者术前及术后3、30、180d的临床资料，比较两组的疗效。结果两组患者的年龄、性别、体质量和室间隔缺损类型差异均无统计学意义（P均〉0．05）。微创组手术时间和住院时间均小于手术组（P均〈0．05）。微创组术中输血的比例小于手术组[2．59％（3／116）比72．12％（75／104），P〈0．01]。术后3d，三尖瓣轻度及以上反流的比例小于手术组[0．86％（1／116）比2．88％（3／104），P〈0．05]。微创组中，1例患者在术后30d出现中量心包积液；手术组患者无心包积液。两组患者随访期间均无心内感染。术后30和180d，微创组术后残余分流比例均小于手术组[1．72％（2／116）比7．69％（8／104）和0比7．69％（8／104），P均〈0．05]。术后3、30、180d，两组经胸超声心动图测量的各房室内径、左心室舒张末期容积指数和左心室射血分数差异均无统计学意义（P均〉0．05）。结论经胸微创封堵术治疗除干下型室间隔缺损以外的单纯室间隔缺损具有与传统的体外循环下手术治疗相似的疗效，并且有手术时间和住院时间短，术中输血、术后发生三尖瓣反流和残余分流比例低的优点。

Objective To compare the efficacy between micro invasive occlusion procedure and extracorporeal circulation procedure for treating patients with simple ventricular septal defect. Methods Two hundred and twenty patients with simple ventricular septal defect （except subarterial ventricular septal defect） were randomly divided into micro invasive group （n = 116） and traditional cardiopulmonary bypass surgery group （ n = 104）. Clinical data were collected and compared at baseline and at 3, 30 and 180 days after surgery. Results Age, gender, body weight and ventricular septal defect type were similar between the two groups （ all P 〉 0. 05 ）. Operation time and hospitalization duration were significantly shorter in the micro invasive group than the traditional cardiopulmonary bypass surgery group （ all P 〈 0. 05 ）. The proportion of blood transfusion was less in micro invasive group than the traditional cardiopulmonary bypass surgery group [ 2. 59% （3/116 ）vs. 72. 12% （75/104）, P 〈 0.01 ]. Three days after surgery, incidence of mild and above tricuspid insufficiency was less in micro invasive group than the traditional cardiopulmonary bypass surgery group [ 0. 86% （1/116） vs. 2. 88% （3/104）, P 〈 0. 05 ]. There was one patient developed mild pericardial effusion at 30 days post surgery in micro invasive group. There was no intracardiac infection in the two groups during follow-up. At 30 and 180 days post surgery, incidence of residual shunt was also less in micro invasive group than the traditional cardiopulmonary bypass surgery group [ 1.72% （2/116） vs. 7.69 （8/104） and 0（0/116） vs. 7. 69（8/104）,all P 〈0.05].After surgery for 3, 30 and 180 days, transthoracic echocardiography derived chamber size, left ventricular end-diastolic volume index and leftventricular ejection fraction were similar between the two groups （ all P 〉 0. 05 ）. Conclusions The efficacy is similar for patients with simple ventricular septal defect （except subarterial ventricular septal defect） using micro invasive occlusion therapy or extracorporeal circulation surgery. Micro invasive occlusion procedure can shorten operation and hospitalization time, and reduce the need for blood transfusion and risk of developing procedural-related tricuspid insufficiency and post-procedural residual shunt.