经皮导管介入封堵与外科微创封堵治疗室间隔缺损的对比研究

Contrastive research of VSD treatment: percutaneous interventional occlusion and microinvasive surgical occlusion

目的比较经皮导管介入封堵与外科微创封堵治疗单纯室间隔缺损的疗效及优缺点,为临床治疗方案提供选择依据。方法回顾性分析2007年3月至2011年1月在武汉亚洲心脏病医院选择封堵治疗的室间隔缺损病例138例,其中行经皮介入封堵治疗82例(介入组),同期行外科微创封堵治疗56例(外科组)。比较两组的疗效、并发症及预后情况。结果介入组82例中2例封堵失败,手术成功率97.6%。发生并发症12例,发生率14.6%。手术时间(30.18±18.24)min,术后住院时间(6.88±0.35)天,住院费用(3.01±0.11)万元。外科组56例微创封堵成功49例,手术成功率88%,7例术中封堵失败转常规开胸手术,发生并发症29例,并发症发生率51.8%,手术时间(79.87±23.58)min,术后住院时间(6.72±1.05)天,住院费用(3.26±0.23)万元。随访2～12个月,两组均无死亡病例。结论两种治疗方法均可有效地治疗单纯室间隔缺损。经皮介入封堵治疗手术时间短,创伤小,并发症少,费用低,不用输血。外科微创封堵无需照射放射线,可在术中随时改变治疗方案。

Objective By comparing the effect, merits and drawbacks of percutaneous interventional occlusion and microinvasive sugical occlusion, the study aims to provide basis for clinical treatment selection. Methods Retrospective analysis was made in 138 patients with VSD, who accepted occlusion in our hospital during March 2007 to January 2011, among whom 82 cases underwent percutaneous intertional occlusion, and the rest had micro invasive sugieal occusion. The outcome, complication and prognosis of the two groups lvere compared. Results In the interventional group, 2 cases failed and the success rate was 97. 6%. Twelve cases had complications （ 14. 6% ）. Operation time was （30. 18 ± 18.24） min and postoperative hospital stay was （6. 88 ±0. 35 ） days. The hospitalization cost was （ 30. 1 ± 1.1 ） thousand. And in microinvasive group, 56 cases were successful （the success rate was 88% ） and 7 cases failed and accepted routine surgery. 29 cases had complications （51.8%）. The operation time was （79. 87 ± 23.58 ） mins and postoperative hospital stay was （6. 72 ± 1.05 ） days. The hospitalization cost was （ 32. 6 ± 2. 3） thousand. After several months of follow up, no death was recorded. Conclusions Both methods can cure simple VSD. For percutaneous intertional approach, the advantages include short operation time, small wound,rare complication, low expenditure and no transfusion. Microinvasive surgery has the virtue of no radiation and can shift to routine operation if necessary.