摘要
目的:比较右胸小切口封堵房间隔缺损、介入封堵治疗房间隔缺损与外科修补术的优缺点。方法:2006年7月～2007年6月,我院采用内科介入封堵、右胸小切口房间隔缺损封堵术与外科修补术治疗房间隔缺损202例,术前和术后随访时行体格检查和心脏超声检查。结果:内科介入封堵术共108例,75例女性,33例男性,平均年龄为21.5岁(10～36岁)。其中80例缺损的边缘均在5 mm以上,78例封堵成功。单纯主动脉边小于5 mm者23例,均封堵成功。下边缘不足4例,后边缘不足2例,房间隔缺损直径38～42 mm,封堵成功2例,2例封堵器脱落,紧急行外科修补手术,2例封堵失败。右胸小切口封堵手术34例,23例女性,11例男性,平均年龄为28.8岁(15～43岁)。20例缺损有充分边缘者(>5 mm)均封堵成功。14例患者1～2个边缘小于5 mm或边缘完全缺乏,后边缘和下边缘缺乏者使用4-0 Prolene线在心脏外面贯穿缝合固定封堵器,34例均封堵成功。外科修补60例,38例女性,22例男性,平均年龄29.3岁(8岁～41岁)。单发缺损52例,8例为双孔缺损,1例3孔缺损,直径16～45 mm,平均(31.3±9.3)mm。外科组的手术成功率为100%。各组均无死亡病例。随访3个月、6个月,内科介入封堵2例患者轻度残余分流,余2组均无残余分流。内科介入封堵、右胸小切口房间隔缺损封堵术与外科修补术平均住院时间为(3.2±1.5)天、(5.0±2.7)天和(8.7±3.4)天(P<0.01)。结论:同外科手术修补相比,内科介入封堵、右胸小切口房间隔缺损封堵术均可安全有效地用于单纯继发孔型ASD的治疗,右胸小切口方法适应证更广,介入封堵方法的住院时间短,创伤更小,美容效果更好。
Objective： The goal of this study was to evaluate percutaneous interventional, intraoperative device closure and surgical closure of seeundum atrial septal defect （ASD）. Methods： Concern has surrounded abandoning conventional midline sternotomy in favor of the less invasive approaches pursuing a better cosmetic result and a more rational resource utilization. A retrospective analy- sis was performed on the patients treated from July 2006 to June 2007. Results ： 202 patients underwent 108 device implants, 34 intraoperative device closure and 60 conventional sternotomy operations. In the percutaneous interventional group, 103 patients devices were successfully deployed. The complete closure rate was 98% （2 of 103 patients）. In the intraoperative device closure group, 34 patients devices were successfully deployed. The complete closure rate was 100% （34 of 34 patients）. In the surgical group, all patients had successful closure immediately after the procedure and at 6 months. No major complications were encountered either during or after the closure procedure in both groups. The mean hospital stay was 3.2 ＋ 1.5d,5.0 ＋ 2.7d and7 _＋ 3.4 d. Conclusions： The success rates for surgical versus device closure of ASD were not statistically different ; however, the complication rate was lower and the length of hos- pital stay was shorter for device closure than for surgical repair. While equally effective compared with sternotomy, the cosmetic appeal of the percutaneous and intraoperative device closure approaches must be weighed against their costs.
出处
《中国民康医学》
2012年第15期1817-1820,1823,共5页
Medical Journal of Chinese People’s Health
关键词
右胸小切口
封堵
房间隔缺损
intraoperative device closure, atrial septal defects
