摘要
目的比较血管造影(DSA)与经食管超声心动图(TEE)引导下行经皮卵圆孔未闭(PFO)封堵术的可行性、安全性和有效性。方法2018年1月—2022年12月,山东第一医科大学第一附属医院住院治疗的不明原因脑卒中和药物治疗无效的PFO相关性偏头痛332例,所有病人均接受经皮PFO封堵术治疗。根据其引导方式分为TEE组101例,DSA组231例;根据病因分为偏头痛组151例和隐匿性脑卒中组181例。回顾性分析病人的临床特征、超声心动图、术中及术后1年随访等临床资料。结果DSA组和TEE组的手术成功率与手术并发症发生率无显著差异,但TEE组的手术时间更长、住院费用更高(t=5.125,Z=8.265,P<0.001)。偏头痛组和隐匿性脑卒中组的手术成功率和并发症发生率与总体结果相一致。随访1年偏头痛亚组DSA和TEE病人的HIT-6评分差异无统计学意义;隐匿性脑卒中亚组DSA病人复发脑卒中3例(2.2%),而TEE病人无脑卒中复发者,但差异无统计学意义。结论TEE和DSA引导下经皮PFO封堵术,在手术成功率、并发症发生及术后1年疗效等方面无明显差异,但在手术时长和住院费用方面DSA病人更具优势。
Objective To investigate the feasibility,safety,and efficacy of digital subtraction angiography(DSA)versus transesophageal echocardiography(TEE)in guiding percutaneous patent foramen ovale(PFO)occlusion.Methods A total of 332 patients with PFO-related migraine due to unexplained stroke or no response to pharmacotherapy who were hospitalized in The First Affiliated Hospital of Shandong First Medical University from January 2018 to December 2022 were enrolled,and all patients underwent percutaneous PFO occlusion.According to the guidance method,they were divided into TEE group with 101 patients and DSA group with 231 patients,and according to the etiology,they were divided into migraine group with 151 patients and occult stroke group with 181 patients.A retrospective analysis was performed for the clinical data including clinical features,echocardiog-raphy,intraoperative data,and one-year postoperative follow-up.Results There wereno significant differences between the DSA group and the TEE groupin surgical success rate and the incidence rate of surgical complications,but the TEE group had a significantly longer time of operation and significantly higher hospitalcosts(t=5.125,Z=8.265,P<0.001).Surgical success rate and the incidence rate of complications in the migraine group and the occult stroke group were consistent with the overall results.One-year follow-up showed no significant difference in HIT-6 score between the patients undergoing DSA and those undergoing TEE in the migraine subgroup;in the occult stroke subgroup,3 patients(2.2%)experienced the recurrence of stroke among the patients undergoing DSA,while no patient experienced such recurrence among the patients undergoing TEE,without a significant difference.Conclusion There areno significant differences between TEE-and DSA-guided percutaneous PFO occlusion in surgical success rate,the incidence rate of complications,and 1-year postoperative outcome,but patients undergoing DSA tend to have advantages in the time of operation and hospital costs.
作者
孙冲
时培轩
宋文慧
武力舟
王海燕
SUN Chong;SHI Peixuan;SONG Wenhui;WU Lizhou;WANG Haiyan(Department of Medical Ultrasound,The First Affiliated Hospital of Shangdong First Medical University&Shandong Provincial Qianfoshan Hospital,Shandong Medicine and Health Key Laboratory of Abdominal Medical Imaging,Jinan 250013,China)
出处
《青岛大学学报（医学版）》
CAS
2024年第4期528-532,共5页
Journal of Qingdao University(Medical Sciences)
基金
山东省自然科学基金面上项目(ZR2023MH-041)。
