经胸微创房间隔缺损封堵术与经导管封堵术治疗小儿房间隔缺损的效果

Efficacy of transthoracic minimally invasive closure of atrial septal defect compared with transcatheter closure in the treatment of atrial septal defect in children

目的:探讨经胸微创房间隔缺损(atrial septal defect,ASD)封堵术与经导管封堵术治疗小儿ASD的疗效。方法:选取2021年1月至2022年2月安徽省儿童医院心血管内科及心血管外科收治的104例ASD患儿为研究对象。根据手术方式的不同分为导管组(n=54)和微创组(n=50)。比较2组手术结果、手术相关指标、术后并发症、术前及术后3个月心功能指标[左心房收缩期内径(left atrial systolic diameter,LAD)、右心室舒张期内径(right ventricular diastolic diameter,RVEDD)、右心室射血分数(right ventricular ejection fraction,RVEF)、右心室面积变化分数(changes of right ventricular area fraction,RVFAC)]的变化。结果:导管组手术成功率为96.30%,微创组手术成功率为98.00%,差异无统计学意义(P>0.05)。导管组手术时间、苏醒时间及住院时间均短于微创组(均P<0.05)。2组术后并发症比较差异无统计学意义(P>0.05)。术后3个月,2组LAD及RVEDD均较术前降低(均P<0.05),2组RVEF及RVFAC均较术前升高(均P<0.05),2组差异无统计学意义(P>0.05)。结论:经胸微创ASD封堵术是治疗小儿ASD的有效术式,其疗效与经导管封堵术相当,尽管术后恢复较慢,但不影响心功能恢复。

Objective:To investigate the effect of transthoracic minimally invasive atrial septal defect(ASD)occlusion and transcatheter closure on ASD in children.Methods:A total of 104 children with ASD who were admitted to the Department of Cardiology and cardiovascular surgery in Anhui Children’s Hospital from January 2020 to February 2022 were selected as research objects and divided into a catheter group(n=54)and a minimally invasive group(n=50)according to the different surgical methods.The operation results,operation-related indexes,postoperative complications,cardiac function indexes[left atrial systolic diameter(LAD),right ventricular diastolic diameter(RVEDD),right ventricular ejection fraction(RVEF),changes of right ventricular area fraction(RVFAC)],at different time points before and 3 months after the operation were compared between the 2 groups.Results:The success rate of operation in the catheter group was 96.30%,and that in the minimally invasive group was 98.00%.There was no significant difference between the 2 groups(P>0.05).The operation time,recovery time,and hospitalization time of the catheter group were significantly shorter than those of the control group(all P<0.05).There was no significant difference in postoperative complications between the 2 groups(P>0.05).At the 3rd month after the operation,LAD and RVEDD in both groups were lower than those before the operation(both P<0.05),there was no significant difference between the 2 groups(P>0.05).Conclusion:Transthoracic minimally invasive ASD occlusion is an effective method in the treatment of ASD in children,and its efficacy is equivalent to that of transcatheter closure.Although the postoperative recovery is slower,it does not affect the recovery of cardiac function.