超声引导下经皮室间隔缺损封堵术与经胸小切口室间隔缺损封堵术疗效比较

Comparison of the effect between ultrasound-guided percutaneous ventricular septal defect closer and transthoracic small incision ventricular septal defect closer

目的比较超声引导下经皮室间隔缺损(VSD)封堵术与经胸小切口VSD封堵术的临床效果和安全性,探讨VSD的最佳手术方式。方法选择2017年1月至2018年1月新乡市中心医院收治的160例VSD患者为研究对象,根据治疗方法分为观察组(82例)和对照组(78例),观察组患者行超声引导下经皮VSD封堵术,对照组患者行超声引导下经胸小切口VSD封堵术。记录2组患者的手术成功率、手术时间、术中失血量、住院时间及住院费用。所有患者于术后即刻、出院当日及术后1、3、6个月行心电图及心脏超声检查,记录心律失常、残余分流、新发主动脉瓣反流、封堵器移位或脱落等并发症情况。结果观察组和对照组患者手术成功率分别为98. 78%(81/82)、100. 00%(78/78),2组患者手术成功率比较差异无统计学意义(χ~2=0. 151,P> 0. 05)。观察组患者手术时间和住院时间显著短于对照组(t=2. 350、1. 981,P <0. 05),观察组患者术中失血量少于对照组(t=2. 522,P <0. 05),2组患者住院费用比较差异无统计学意义(t=0. 921,P> 0. 05)。观察组和对照组患者术后并发症发生率分别为2. 44%(2/82)、11. 54%(9/78),观察组患者术后并发症发生率低于对照组(χ~2=5. 171,P <0. 05)。结论超声引导下经皮VSD封堵术具有微创、无需体外循环、操作简单、安全性高、术后并发症发生率低等优点。

Objective To compare the clinical efficacy and safety of ultrasound-guided percutaneous ventricular septal defect( VSD) closer and transthoracic small incision VSD closer,and to investigate the best surgical method for VSD.Methods A total of 160 patients with VSD in the Central Hospital of Xinxiang City from January 2017 to January 2018 were selected as the study subjects,and the patients were divided into observation group( n = 82) and control group( n = 78)according to the treatment methods. The patients in the observation group underwent ultrasound-guided percutaneous VSD closer,while the patients in the control group underwent ultrasound-guided transthoracic small incision VSD closer. The success rate of operation,operation time,intraoperative bleeding volume,hospitalization time and hospitalization expenses of the patients in the two groups were recorded. The complications of arrhythmia,residual shunt,new aortic regurgitation,occluder displacement or abscission in all patients were observed by electrocardiogram and echocardiography at the end of the operation,the day of discharge from hospital and 1,3 and 6 months after operation. Results The success rate of operation in the observation group and control group was 98. 78%( 81/82) and 100. 00%( 78/78),respectively. There was no significant difference in the success rate of operation between the two groups( χ~2= 0. 151,P > 0. 05). The operation time and hospitalization time in the observation group were significantly shorter than those in the control group( t = 2. 350,1. 981;P <0. 05). The intraoperative bleeding volume in the observation group was less than that in the control group( t = 2. 522,P <0. 05). There was no significant difference in the hospitalization expenses between the two groups( t = 0. 921,P > 0. 05). The incidence of postoperative complications in the observation group and the control group was 2. 44%( 2/82) and 11. 54%( 9/78),respectively. The incidence of postoperative complications in the observation group was lower than that in the control group( χ~2= 5. 171,P < 0. 05). Conclusion Ultrasound-guided percutaneous VSD closer has the advantages of minimally invasive,no cardiopulmonary bypass,simple operation,high safety and low incidence of postoperative complications.