介入封堵与外科手术治疗婴幼儿动脉导管未闭合并肺动脉高压的对比研究

Comparative study on closure of patent ductus arteriosus combined with pulmonary hypertention in infants by transcatheter closure and by surgery

目的对比研究介入封堵与外科手术治疗婴幼儿动脉导管未闭合并肺动脉高压(PDA)的临床疗效,探讨应用国产封堵器介入治疗婴幼儿PDA的临床价值和安全性。方法 2010年1月至2012年12月采用国产封堵器介入封堵治疗的婴幼儿PDA患者52例,同期采用外科手术治疗的PDA患者48例,比较两种方法的疗效、主要并发症及远期疗效等。结果两种疗法的技术成功率(介入组98.1%、外科组97.9%)无显著性差异(P>0.05),介入组有1例封堵未成功择期行外科手术治疗,外科组有1例PDA结扎术后残余漏择期又行介入封堵治疗;主要并发症发生率有显著性差异(P<0.05)(介入封堵组1.96%、外科手术组14.6%),介入封堵组有1例发生三尖瓣关闭不全,外科手术组并发症有7例:进行性血胸二次开胸止血2例,肺不张2例,气胸1例,喉返神经损伤1例,刀口感染1例,术后接受输血8例、呼吸机辅助通气16例,介入组无1例接受输血和呼吸机辅助通;术后住院时间介入组平均(4.3±1.2)d,外科组平均(11.2±3.3)d,两组比较均有显著性差异(P<0.05);两组远期随访均生存良好,肺动脉压力下降程度及心功能改善情况无显著性差异(P>0.05)。结论国产封堵器介入治疗婴幼儿PDA安全可靠,具有良好的临床可行性和安全性,创伤小、并发症少,住院时间短,可作为婴幼儿PDA治疗的首选方法。

Objective To compare the clinical effectiveness of transcatheter closure with that of surgical closure of patent ductus arteriosus （PDA） combined with pulmonary hypertension in infants, and to evaluate clinical values and the feasibility of domestic transcatheter PDA occlu- der. Methods From Jan. 2010 to Dec. 2012, 52 patients underwent transcatheter PDA closure using transcatheter occlude. 48 patents under- went surgical closure of PDA. The case - control study was adopted to compare the effectiveness, main complications and long - term outcome. Re- suits The success rate was 98.1% in transcatheter group and 97.9% in surgical group, There was no significant differences between two groups （ P 〉 0.05 ）. One case of transcatheter group suffered failure of transcatheter closure, and underwent surgery selectively. One case of surgical group underwent transcatheter closure because of residual shunt. There was significant differences about major complication rate between two groups （ P 〈0.05 ）. The complication rate of transcatheter group was 1.96% and surgical group 14.6% respectively. Tricuspid insufficiency occurred in one case of transcatheter group. Complications existed in seven cases of surgical group. Progressive hemothorax occurred in two cases of surgicalgroup, atelectasis in two cases, pneumothorax in one case, injury of recurrent laryngeal nerve in one case, incision infection in one case. In surgi- cal group, 8 cases accepted blood transfusion and 8 needed assisted respiration. There was no case that accepted blood transfusion or assisted respi- ration. The length of postoperative hospital stay was （4.3 ± 1.2） days in transcatheter group and （ 11.2 ± 3.3 ） days in surgical group. There were significant differences between two groups （ P 〈0.05 ）. The patients all show good long- term results. There were no significant differences be- tween two groups about pulmonary artery pressure and heart function （ P 〉 O. 05 ）. Conclusion Transcatheter closure of PDA in infants using domestic occluder is an ideal procedure with favorable clinical feasibility, safety, reliability, min - invasiveness and short hospitalization. This method may become preferable for PDA closure in infants.