经胸小切口封堵与经皮介入封堵术治疗房间隔缺损的比较

Treatment of atrial septal defect: minimally invasive occlusion procedure vs percutaneous interventional occlusion

目的比较经胸微创小切口封堵术与经皮介入封堵术治疗继发孔型房间隔缺损（ASD）的效果及各自优缺点。方法回顾性分析2004年1月-2014年8月接受封堵治疗的146例ASD患者的临床资料。将患者分成2组,经胸组（43例）采用经食管超声心动图（TEE）引导下微创小切口封堵术,经皮组（103例）采用数字减影血管造影技术（DSA）和TEE引导下介入封堵术。收集患者术前及术后临床资料,比较两种方法的疗效、费用等情况。结果两组患者的年龄、性别、体质量和房间隔缺损断径大小差异均无统计学意义（P〉0.05）。经皮组手术时间和术后住院时间及住院费用均小于经胸组（P〈0.05）。经胸组全部封堵成功,经皮组2例封堵失败后转外科急诊手术治疗。两组均无输血及死亡病例。术后1个月复查经TTE测量的左房前后径、左室舒张末内径较术前减小（P均〈0.05）,残余分流情况、左心室射血分数及右室内径差异无统计学意义（P均〉0.05）。结论两种方法均为微创手术,均可安全有效地用于单纯继发孔型ASD的治疗。经胸微创小切口封堵方法的成功率高,不需接受射线,适应证更广;而介入封堵方法的手术时间和住院时间更短,费用低,创伤更小,美容效果更好。

Objective To compare the clinical efficacy,advantages and disadvantages between minimally invasive occlusion procedure and percutaneous interventional occlusion for treating patients with atrial septal defect（ ASD）.Methods The clinical data of 146 ASD patients treated during Jan. 2004 and Aug. 2014 were retrospectively analyzed. The patients were divided into 2 groups： group A（ n = 43） were treated with minimally invasive occlusion procedure under the guidance of transesophageal echocardiography（ TEE）; group B（ n = 103） received percutaneous interventional occlusion guided by TEE and digital subtraction angiography（ DSA）. Clinical data before and after the surgery were collected; efficacy and cost of both approaches were compared. Results Age,gender,body weight and diameter of ASD were similar between the two groups（ all P〈0. 05）. Operation time,postoperative hospital stay and mean total cost were significantly lower in group B than in group A（ all P〈0. 05）. All cases in group A were successfully occluded with satisfactory results. The 2 unsuccessful patients in group B switched to emergency surgical operation. No patients in both groups needed blood transfusion and no death occurred. One month after operation,transthoracic echocardiography（ TTE） derived diameters of left atrial and left ventricular were smaller than those preoperative（ both P〈0. 05）. Incidence of residual shunt,and left ventricular ejection fraction were similar before and 1 monthafter operation（ both P〈0. 05）. Conclusion The two approaches are both minimally invasive operation for treating ASD,which can be performed safely and effectively. Minimally invasive occlusion procedure does not need X-ray,and has higher success rate and wider indications than percutaneous interventional occlusion. Percutaneous interventional occlusion shortens the operation time and hospitalization,has lower medical cost,and provides better cosmetic results.