外科修复和基于临床路径的经导管封堵膜周部室间隔缺损对比研究

Comparison of surgical repair and clinical pathway guided transcatheter closure of perimembranous ventricular septal defect

目的回顾性地比较外科修复和基于临床路径的经导管封堵膜周部室间隔缺损的安全性、有效性和经济性。方法 2016年12月到2017年12月,共206名膜周部室间隔缺损患者接受外科手术修复(n=100)和临床路径指导下的经导管封堵手术(n=106)的医学资料被回顾并进行对比研究。患者相关临床数据、住院时长及费用等被纳入评估。结果两组患者均未发生死亡或主要并发症。常规外科组有21名(21.0%)、经导管组有6名(5.7%)患者出现次要并发症(P=0.006)。两组间费用没有显示出统计学差异[(49419.2±12376.7)元vs.(51964.5±15151.4)元,P=0.190]。经导管组的住院时长更短[(3.5±1.6)d vs.(11.6±3.3)d,P <0.001]。结论外科修复和经导管封堵同为修复膜周部室间隔缺损的有效方式。基于临床路径的经导管封堵术诊疗流程规范有序,使次要并发症发生率显著降低,是未来继续探索实践的方向。

Objective The research was performed to compare the safety and efficacy of the transcatheter closure guided by clinical pathway versus surgical procedure to correct perimembranous ventricular septal defect (pmVSD).Methods 206 patients with pmVSD who had received surgical repair or transcatheter closure in a clinical pathway from December 2016 to December 2017 were reviewed for a comparative investigation.Clinical data,hospital stay and costs were evaluated.Results Neither group had mortality or major complications.Minor complications occurred in 21 surgical (21.0%) and 6 percutaneous (5.7%) procedures (P=0.006).The cost didn't show any significant difference between the two groups (RMB 49 419.2±12 376.7 vs.RMB 51 964.5±15 151.4,P=0.190).The hospital stay was shorter in the transcatheter group than that in the surgical group (3.5±1.6 days vs.11.6±3.3 days,P<0.001).Conclusion Both surgical repair and transcatheter occlusion were effective treatments with similar success rates.Patients receiving transcatheter closure based on a clinical pathway had fewer minor complications and it might be the direction in which we should continue in the future.