房间隔缺损介入治疗和外科手术的对比分析
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| 时间：2009-02-10 18:18:03 来源： 作者： |
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Contrast analysis between transcatheter and surgical closure methods in patients with atrial septal defect/WU Guang|wei, LIN Ying|zhong, WANG Meng|jie，LU Zhi|hong,ZHAO Yi|lan, HU Chang|xing//
Abstract：Objective:To compare the safety , efficacy, complications and cost between transcatheter and surgical closure methods in patients with atrial septal defect (ASD).Methods:Retrospective analysis was done on 148 patients with secondum atrial septal defects: 66 cases were treated surgically and 82 cases were treated by transcatheter closure.The safety , efficacy, complications and cost between two groups were compared.Results:The instant procedural success rate was 95.1% for the transcatheter closure group and 100% for the surgical closure group (P=0.018 ).Total complication rates both of the transcatheter closure group and the surgical closure group were 18.3% and 34.8 % respectively (P<0.05), Blood products were administered to 36 patients in the surgical group and no patient in the transcatheter closure group (P<0.01).Mean operation time both of the transcatheter closure group and the surgical closure group was(48±12.2) min and (158±16.4) min（P<0.001 ）；days of stay in hospital were (6.0±2.0) days in transcatheter occlude group,(13.0 ±3.0) days in surgery group respectively.Cost both of the transcatheter closure group and the surgical closure group were RMB (26729±1675) and RMB (22393±1739) respectively (P<0.05).Conclusion:Transcatheter closure of secondum ASD with Amplatzer septal occluder is an efficient, non|surgical,and safe method although its success rate is lower.
Author′s address：Department of Cardiology, The People’s Hospital of Guangxi，Nanning，Guangxi，530021，China
Key words：Heart catheterization;Surgery;Atrial septal defect
外科手术治疗单纯房间隔缺损（ASD）已经十分成熟，死亡率很低。但外科手术需正中劈开胸骨或侧切截断肋骨，需体外循环，手术本身有时会产生心包积液、胸骨疼痛、术后感染等并发症；且术后住院时间长，患者留有永久疤痕，影响美观。自从1974 年King 及1977 年Rashkind分别采用不同器械成功地实施介入性封堵术以来，随着介入器材的不断研制和发展，特别是1997年美国Amplatzer封堵伞及其后国内蘑菇伞的问世，使房间隔缺损封堵的技术和器材日趋完善,从而促进了其在全球的推广。经导管法介入治疗ASD是一种微创而且安全的治疗方法［1～3］。本研究比较经导管介入治疗和外科手术治疗继发孔型ASD的疗效及优缺点，为临床上提供优选依据。
1 资料与方法
1.1 一般资料收集、记录并随访2004年1月至2006年12月在我院应用导管法介入治疗的继发孔型ASD患者和同期外科手术治疗的继发孔型ASD患者，按如下标准选择病例：缺损直径5～36 mm，伴右心容量负荷增加的继发孔型左向右分流ASD；年龄在3岁以上；超声心动图证实缺损边缘条件合适，既可行封堵术也可行外科手术治疗。排除标准：超声心动图ASD直径>36 mm，证实ASD解剖条件不适宜行封堵术；行封堵治疗失败；心房水平有右向左分流；合并其他需要手术矫治的心脏畸形或病变，但不包括同时行三尖瓣成形术的情况。符合上述条件的患者共148例。其中介入治疗组82例，男46例，女36例；年龄3～71，平均（36.25±12.63）岁。ASD直径平均为（25.00±5.60）mm，外科手术组66例，男35例，女31例；年龄3～56，平均（37.00±12.58）岁。ASD直径为（29.75±5.06）mm，两组一般资料无显著差异（P>0.05。
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