经食管超声引导三种不同路径封堵婴幼儿房间隔缺损的对比分析

Comparative Analysis of Three Different Ways to Occlude Atrial Septal Defectin Infants Guided by Trans-esophageal Echocardiography

目的分析比较经食管超声心动图检查(TEE)引导下三种不同路径行外科微创封堵术治疗婴幼儿房间隔缺损(ASD)的临床资料,探讨适宜的ASD外科封堵方案。方法回顾性分析2019年1月1日—12月31日于郑州大学附属儿童医院住院治疗的91例TEE引导行ASD封堵术患儿的临床资料,按实施手术路径的不同分为三组:经股静脉封堵组(股静脉组)(28例)、经颈静脉封堵组(颈静脉组)(20例)和经右腋下小切口封堵组(右腋下组)(43例)。记录分析三组患儿的平均年龄、体重、缺损大小、手术成功率、手术时间、住院时间及并发症发生情况等。结果三组手术时间、出血量、住院时间及并发症发生情况无显著差异。三组手术时平均年龄、体重及缺损大小差异存在统计学意义(P均<0.05);两两比较,颈静脉组手术年龄和体重大于右腋下组(P均<0.05),但小于股静脉组(P均<0.05),右腋下组缺损直径小于颈静脉组和股静脉组(P均<0.05),而颈静脉组缺损大小与股静脉组差异无统计学意义(P=0.156)。结论三种路径都能安全有效地实施经TEE引导的ASD外科微创封堵术;经股静脉及颈静脉路径创伤最小,但需严苛的条件;右腋下路径有更宽的适应证,切口隐蔽,亦符合微创理念;应个体化地选择封堵路径,使患儿获益最大。

Objective To analyze and compare the clinical data of minimally invasive surgical closure of atrial septal defect(ASD)in infants under the guidance of trans-esophageal echocardiography(TEE),and to explore the appropriate surgical closure scheme of ASD.Methods The clinical data of 91 patients with ASD occlusion guided by TEE who were hospitalized in Children's Hospital Affiliated to Zhengzhou University from January 1,2019 to December 31,2019 were analyzed retrospectively.They were divided into three groups according to the different surgical paths:femoral vein occlusion group(28 cases in femoral vein group);transjugular vein occlusion group(20 cases in jugular vein group);blocking group through right subaxillary small incision(43 cases in right subaxillary group).The average age,weight,defect size,operation success rate,operation time,hospitalization time and complications of the three groups were recorded and analyzed.Results There was no significant difference in operation time,blood loss,hospitalization time and complications among the three groups.There were significant differences in average age,weight and defect size among the three groups(P<0.05).In pairwise comparison,the operative age and weight of jugular vein group were larger than those of right subaxillary group(P<0.05),but smaller than those of femoral vein group(P<0.05).The defect size of right subaxillary group was smaller than that of jugular vein group and femoral vein group(P<0.05),but there was no significant difference between jugular vein group and femoral vein group(P=0.156).Conclusion All three approaches can safely and effectively implement minimally invasive ASD surgical occlusion guided by TEE.The trauma through femoral vein and jugular vein pathway is the least,but it needs strict conditions.The right subaxillary path has wider indications and hidden incision,which is also in line with the concept of minimally invasive surgery.The blocking path should be selected individually to maximize the benefit of children.