经胸封堵与正中开胸修补室间隔缺损的倾向性评分对比

TEE guided minimally invasive transthoracic device closure of ventricular septal defect versus conventional thoracotomy: a comparative study of propensity score matching

目的利用倾向性评分对比匹配法比较经胸封堵与开胸修补室间隔缺损效果差异,探讨经胸封堵室间隔缺损的治疗效果及安全性。方法选取2014年5月至2016年5月在我院行单纯室间隔缺损治疗患儿368例,其中经胸封堵组40例(微创组),正中开胸手术修补328例,利用倾向性评分匹配对比研究的方法,找出与经胸封堵组最匹配的40例(开胸组)进行对比研究。结果封堵组在手术时间[(1.97±0.48)h vs.(3.55±1.95)h]、ICU停留时间[(21.15±30.52)h vs.(38.37±10.91)h]、胸液量[(28.39±32.67)mL vs.(174.84±85.36)mL]、手术切口长度[(2.98±0.72)cm vs.(11.76±2.89)cm]等较正中开胸组明显改善,两组间在术后瓣膜返流、心律失常、残余分流等并发症未见明显差异。随访期间两组生存及并发症无明显异常。结论经胸微创封堵婴儿室间隔缺损近期及中期治疗效果肯定,是安全可行的术式;具有创伤小、出血少,恢复快等优点。

Objective To compare the difference between transthoracic device closure of ventricular septal defect and conventional thoracotomy and examine the effect and safety of transesophageal echocardiography （TEE） guided minimally invasive transthoracic device closure of ventricular septal defect. Methods Three hun- dred and sixty-eight patients underwent isolated ventricular septal defect surgery in our hospital from May 2014 to May 2016. There were 40 patients in group A underwent TEE guided minimally invasive transthoracic device clo- sure of ventricular septal defect and 328 patients in group B underwent conventional thoracotomy surgery. By using the method of propensity score matching, we selected 40 conventional thoracotomy patients as a control group in our study. Results All patients were survived after surgery without death and other serious complications. Compared with conventional thoracotomy surgery, patient with transthoraeic device closure of ventrieular septal defect had sta- tistical improvement in surgery time （1.97± 0.48 vs. 3.55 ± 1.95）h, ICU stayed time （21.15± 30.52 vs. 38.37± 10.91 ）h,volume of thoracic drainag （28.39 ± 32.67 vs. 174.84 ± 85.36 ）mL, surgery incision length （2.98 ±0.72 vs. 11.76 ± 2.89）cm. There were no significant differences in postoperative valvular regurgitation, arrhythmia and resid- ual shunt between the two groups. Conclusion TEE guided minimally invasive transthoracic device closure of ven- tricular septal defect is safe, effective, feasible, less trauma, less bleeding, faster recovery and etc.