房间隔缺损经胸与经皮封堵的单中心对比研究

Comparative study of transthoracic and percutaneous closures of atrial septal defect in a single center

目的:比较先天性房间隔缺损的经胸与经皮封堵治疗,分析术前及术中、术后出现的并发症,对比两种手术的临床疗效及优缺点,为选择微创手术方式提供参考。方法:回顾宁夏医科大学总医院心脏中心心脏大血管外科,2014年1月至2018年12月期间,收治的先天性房间隔缺损经微创手术封堵的患者,根据接受的手术方式的不同分为两组:经胸组患者接受食道超声引导下经胸小切口封堵,经皮组患者接受放射线引导下经皮导管封堵。根据术前、术后的心脏超声、心电图、胸X线片检查结果,收集患者年龄、体质量、住院时间、费用、缺损直径、使用封堵器直径、手术成功率、术后并发症,对所收集的数据进行统计学分析,对比两种术式的优缺点。结果:本研究共纳入患者315例。经胸组161例,经皮组154例。两组患者的房间隔缺损直径及使用封堵器直径差异无统计学意义(P>0.05)。其中经胸组封堵失败3例,经皮组封堵失败1例,手术成功率差异无统计学意义(P>0.05)。对于年龄、体质量,经胸组小于经皮组,差异有统计学意义(P<0.01),住院费用经胸组低于经皮组(P<0.05),手术时长及住院天数经胸组长于经皮组(P<0.05)。在术后并发症方面,经胸组胸腔积液、气胸及肺部炎症明显高于经皮组(P<0.05),但是残余分流、心律失常、肺动脉高压、心包积液、瓣膜反流两组差异无统计学意义。结论:经皮封堵手术时间短,并发症少且术后恢复快。经胸小切口封堵术也可有效、安全的封堵房间隔缺损,而且在年龄、体质量上有更广泛的适应范围,更易于开展,但是在胸腔积液、气胸及肺部炎症发生率较高是其存在的问题,应恰当选择适应证。

Objective:To compare and analyze the advantages and disadvantages of transthoracic and percutaneous closures of atrial septal defect,and to provide a reference for the choice of two minimally invasive approaches.Methods:Patients who underwent surgical closure of atrial septal defect from January 2014 to December 2018 in Cardiovascular Surgery of General Hospital of Ningxia Medical University were reviewed.They were divided into two groups which are the transthoracic group and the percutaneous group.The data of patient were collected in terms of age,weight,length of stay,cost,defect diameter,diameter of occlude,surgical success rate,postoperative complications,echocardiography,electrocardiogram,chest radiograph.Based on the statistical result,the clinical effects of the two different surgical method were compared and analyzed.Results:Of 315 patients enrolled in this study were 161 cases in the transthoracic group,and 154 cases in the percutaneous group.There were no significant differences of the diameter of atrial septal defect and the diameter of occluder(P>0.05).There were 3 cases of failure in the transthoracic group and 1 cases of failure in the percutaneous group.There were no statistical differences in the success rate between two groups(P>0.05).The age and weight in transthoracic group are significantly smaller than in percutaneous group(P<0.01).The cost of hospitalization in the transthoracic group is significantly lower than in the percutaneous group(P<0.05).The time of operation and hospital stay were significantly longer in the transthoracic group than in the percutaneous group(P<0.05).The postoperative complications in transthoracic group were significantly higher than in percutaneous group(P<0.05).As to the postoperative complications,pleural effusion,pneumothorax and pulmonary inflammation in the transthoracic group were significantly higher than those in the percutaneous group.However,postoperatively,there were no significant differences in residual shunt,arrhythmia,pulmonary hypertension and pericardial effusion postoperatively between the two groups.Conclusions:Percutaneous has the more advantageous comparatively in terms of operation time,postoperative complications,and quick recovery than transthoracic approach.Transthoracic approaches can also effectively and safely closure atrial septal defect,and has a wider range of age and weight,which is easier to carry out.However,the high incidence of pleural effusion,pneumothorax and pulmonary inflammation is its problem,and the indications should be selected appropriately.