经胸与经皮房间隔缺损封堵术的临床疗效比较

Comparison of clinical efficacy between transthoracic and percutaneous atrial septal defect closure

目的:对比分析经胸封堵术与经皮封堵术在治疗房间隔缺损患者中的临床效果。方法:回顾性分析2019年6月至2021年6月在我院诊断为继发孔型房间隔缺损并行房间隔缺损封堵术的患者63例。按照手术方式分为经胸封堵组(食道超声引导下经胸小切口房间隔缺损封堵术,n=30)和经皮封堵组(食道超声引导下经皮房间隔缺损封堵术,n=33)。比较两组手术时间、术中出血量、术后住院时间、术后并发症、术后VAS评分等指标。结果:经皮封堵组平均手术时间短于经胸封堵组,但差异无统计学意义(P>0.05);经皮封堵组术后住院时间、术中出血量少于经胸封堵组,差异有统计学意义(P<0.05);经皮封堵组在术后8 h疼痛视觉模拟评分分值低于经胸封堵组,差异有统计学意义(P<0.05);经胸封堵组术后并发症共7例,经皮封堵组术后并发症共2例,经胸封堵组术后并发症发生率高于经皮封堵组,差异有统计学意义(P<0.05)。结论:经皮房间隔封堵术对比经胸房间隔封堵术在术后住院时间、术中出血量、术后并发症、术后疼痛方面具有较为明显的优势,其创伤更小,瘢痕更加隐蔽,呼吸系统并发症少。

Objective :To compare the clinical effects of transthoracic closure and percutaneous closure in the treatment of atrial septal defect.Methods:Analysis was made about 63 cases who were diagnosed with secondary atrial septal defect and underwent atrial septal defect closure in Ganzhou People’s Hospital from June 2019 to June 2021. According to the surgical methods,they were divided into transthoracic closure group(transthoracic small incision atrial septal defect closure under esophageal ultrasound guidance,n=30)and transcapping skin group(esophageal ultrasound guided percutaneous atrial septal defect closure,n=33). Indexes such as operation time,intraoperative blood loss,postoperative hospital stay,postoperative complications,and postoperative VAS score were collected between the two groups.Results :The average operation time of the percutaneous occlusion group was shorter than that of the transthoracic group,but the difference was not statistically significant(P>0. 05);the postoperative hospital stay and surgical blood loss of the percutaneous group were significantly less than those of the transthoracic group,with statistical significance(P<0. 05);the visual analogue score of pain in the transthoracic closure group at 8 hours after surgery was lower than that of the transthoracic closure group,and the difference was statistically significant(P<0. 05);There were 7 cases of postoperative complications in the percutaneous closure group and 2 cases in the percutaneous closure group. The incidence of postoperative complications in the transthoracic group was significantly higher than that in the percutaneous group,with statistical significance(P<0. 05).Conclusion :Compared with transthoracic atrial septal closure,percutaneous atrial septal closure is more obvious in terms of postoperative hospital stay,intraoperative blood loss,postoperative complications,and postoperative pain. Also,it has less trauma and scars(more hidden). There are fewer respiratory complications,which has certain clinical application prospects.