小儿室间隔缺损3种不同手术方式的对比分析

Comparison on three procedures for treating ventricular septal defects in children

摘要:

目的：对经皮导管介入封堵术、直视修补术和经胸微创封堵术3种治疗小儿室间隔缺损（ventricular septal defect，VSD）的手术方式进行回顾性对比分析以有助于VSD手术方式的合理化选择。方法：2011年1月1日至2011年12月31日在我院分别行经皮导管介入封堵术（介入组，n=123）、直视修补术（直视组，n=104）和经胸微创封堵术（微创组，n=23）的VSD患儿共250例，比较3组的手术时间、输血量、术后机械通气时间、术后重症监护室（intensive care unit，ICU）监护时间、术后住院时间、成功率和并发症发生率。结果：直视组手术时间、输血量、术后机械通气时间、术后ICU监护时间、术后住院时间明显大于介入组和微创组（P<0.001）。介入组无需输血、机械通气和ICU监护；微创组手术时间和术后住院时间明显长于介入组（P<0.001）。3组手术成功率和主要并发症发生率比较无统计学差别（P >0.05）。结论：3种手术方式均是治疗VSD安全、有效的方法。应充分评估病情，根据不同的手术适应证选择合适的手术方式。

Abstract:

Objective：To compare three different procedures，including percutaneous transcatheter closure，open-heart surgery and transthoracic minimally invasive surgery and to analyze which procedure is possibly the best option in treatment of ventricular septal defect（VSD） in children. Methods：The study involved 250 children with VSD in our hospital during the period from January 1，2011 to December 31，2011. One hundred and twenty-three children were treated by percutaneous transcatheter closure（transcatheter group），104 by traditional open-heart surgery（open-heart group） and 23 by transthoracic minimally invasive surgery（minimally inva－sive surgery group）. Results：Operation time，volume of blood transfusion，postoperative ventilation duration，intensive care unit（ICU） care duration，hospitalized duration were significantly longer in open-heart group than in transcatheter group and minimally inva－sive surgery group（P<0.001）. Blood transfusion，mechanical ventilation and ICU care were unneeded in transcatheter group. Opera－tion time and postoperative hospitalized duration in minimally invasive surgery group were significantly longer than those in tran－scatheter group（P<0.001）. There was no statistical difference in operation success rate and major complication incidences among three groups（P >0.05）. Conclusions：Three procedures are all safe and effective in treating VSD. Condition should be fully assessed and right procedure should be chosen according to different indications.