超声心动图引导经胸微创房间隔缺损封堵术与经导管封堵术的对比研究

Comparative study of transthoracic minimally invasive closure and transcatheter closure of atrial septal defect guided by echocardiography

摘要:

目的：对比超声心动图引导经胸微创房间隔缺损封堵术与经导管封堵术的治疗效果。方法：选取陆军军医大学第二附属医院经胸微创封堵房间隔缺损（atrial septal defect，ASD）80例为研究组，经导管房间隔缺损封堵112例为对照组，采用统计学方法对2组进行比较。结果：研究组封堵成功79例，失败1例，成功率98.8%；对照组封堵成功109例，失败3例，成功率97.3%。研究组术后有3例残留少量心包积液，其余无其他并发症；对照组术后发现1例股静脉血栓，1例穿刺处血肿，5例少量心包积液。所有病例随访1年，研究组及对照组患者的右房横径、右室横径及肺动脉直径均较术前明显缩小，三尖瓣反流面积减轻，差异有统计学意义（P<0.01）。研究组使用的封堵器大小与超声心动图评价的ASD最大径呈正相关（r=0.940，P<0.01），对照组使用的封堵器大小与超声心动图筛选的ASD最大径亦呈正相关（r=0.928，P<0.01），研究组的相关性略高于对照组。结论：经胸微创房间隔缺损封堵术治疗房间隔缺损成功率高，并发症少，治疗效果不亚于经导管封堵术，有重要临床推广价值。

Abstract:

Objective：To compare the therapeutic effects of transthoracic minimally invasive closure and transcatheter closure of atrial septal defect（ASD） guided by echocardiography. Methods：In the study，80 patients treated with transthoracic minimally invasive clo－sure of atrial septal defect were selected as the study group，and 112 with transcatheter closure of atrial septal defect were selected as control group. Statistical methods were used for the comparison between the two groups. Results：In the study group，79 cases were successfully occluded and 1 case failed，with a success rate of 98.8%；in the control group，109 cases were successfully occluded and 3 cases failed，with a success rate of 97.3%. In the study group，there were 3 cases of residual pericardial effusion after operation，and the rest had no other complications；1 cases of femoral vein thrombosis，1 cases of puncture hematoma and 5 cases of pericardial effusion were found in the control group after operation. All patients were followed up for one year. The transverse diameter of right atrium，right ventricle and pulmonary artery in the study group and the control group were both significantly smaller than those before operation，and the area of tricuspid regurgitation was significantly reduced（P<0.01）. The type of occluder used in the study group was positively correlated with the maximum diameter of ASD screened by echocardiography（r=0.940，P<0.01）. The type of occluder used in the control group was also positively correlated with the maximum diameter of ASD screened by echocardiography（r=0.928，P<0.01），and the correlation in the study group was slightly higher than that in the control group. Conclusion：Transthoracic minimally invasive closure of atrial septal defect has a high success rate and few complications. The therapeutic effect is better than that of transcatheter closure，and it is of important clinical value.