微创经胸房缺伞堵术治疗大直径房间隔缺损45例临床分析

Clinical analysis of minimally invasive transthoracic ASD transcatheter closure in treatment of large diameter atrial septal defects in 45 cases

目的观察微创经胸房缺伞堵术与体外循环直视修补术对大直径房间隔缺损的疗效。方法纳入我院2010年1月～2014年1月收治的大直径房间隔缺损患者90例,根据手术方案的不同分为研究组与对照组,研究组采用微创经胸房缺伞堵术,对照组采用体外循环直视修补术。观察比较两组手术成功率、残余分流、心律失常、心功能不全、感染、手术时间、输血量、住院时间等指标。结果研究组与对照组手术封堵成功率分别为95.56%、93.33%,差异无显著性（P〉0.05）;研究组肺部感染、心包积液与胸腔积液发生率分别为2.22%、0、0,对照组分别为34.29%、17.14%、28.57%,研究组均明显低于对照组（P〈0.05）;研究组的手术时间、术中输血量及住院时间等指标均明显优于对照组（P〈0.05）。结论微创经胸房缺伞堵术治疗大直径房间隔缺损的临床疗效确切,术中对患者的损伤较小,术后患者恢复较快,且并发症发生率较低,值得推广。

Objective To observe the curative effects of minimally invasive transthoracic ASD transcatheter closure on large diameter atrial septal defects. Methods 90 cases of large diameter atrial septal defects hospitalized between January 2010 and January 2014 were enrolled and divided into research and control groups according to the operation schemes. The research group was treated by minimally invasive transthoracic ASD transcatheter closure, and the control group was treated by extracorporeal circulation open operation. Observation and comparison were made in the surgical success rate, residual shunt, arrhythmia, cardiac insufficiency, infections, operation time, blood transfusion volume, length of hospital stay and other indicators between the two groups. Results The surgical success rates of blocking in the two groups were 95.56% and 93.33%, respectively, and the difference was not significant （P 〉 0.05）. The incidence of pulmonary infection, pericardial effusion, and pleural effusion was 2.22%, 0, 0, and that of the control group was 34.29%, 17.14%, and 28.57%, respectively. That of the research group was significantly lower than that of the control group （P 〈 0.05）. The operation time, intraoperative blood transfusion volume, and length of hospital stay in the research group were all superior to those in the control group （P 〈 0.05）. Conclusion Minimally invasive transthoracic ASD transcatheter closure on the treatment of large diameter atrial septal defects has certain clinical curative effects and causes small injury to patients which results in fast postoperative recovery. It also has lower incidence of complications and is worthwhile to be promoted.