超声心动图结合临床评价房间隔缺损介入治疗和外科治疗

目的以18周岁为年龄分界、以20 mm为房间隔缺损(atrial septal defect,ASD)大小分界,比较经导管封堵和外科手术2种治疗方法的安全性和有效性。方法按照患者年龄及房间隔缺损大小分为4组,其中每组又各自按治疗方法分为介入亚组及手术亚组。分别比较每组中不同亚组的技术成功率、并发症、残余分流、手术时间、ICU时间、住院时间、输血量等。结果 (1)相同条件下,介入亚组和外科亚组技术成功率、残余分流发生率方面无显著性差异。(2)介入亚组在并发症发生率和输血量方面低于外科亚组。操作时间、ICU监护时间及住院时间均显著短于外科亚组。(3)四个介入亚组之间的技术成功率、并发症发生率、残余分流发生率、手术时间、住院时间、输血量等差异均无统计学意义。结论 (1)2种治疗方法均安全有效。(2)对于不同年龄、不同大小房间隔缺损患者,只要适应证选择合理,介入治疗因其微创性而更具有优势。(3)ASD介入封堵的优越性不受年龄及缺损大小的限制。

Contrast analysis between transcatheter and surgical closure methods in patients with atrial septal defect

Objective To compare the safety,efficacy,complications between transcatheter and surgical closure methods in patients of various years and various sizes of ASD.Methods Retrospective analysis was done on secondum atrial septal defects.The safety,efficacy,complications between every two relative sub-groups were compared.Results(1)The differences between technical success rate and residual shunt of each subgroup in every group were not significant.(2)The incidence of complications,blood transfusion volume of surgical therapy subgroup were higher than intervention subgroups,ICU staying days,hospitalization days were longer than intervention subgroups.(3)The technical success rate of the 4 intervention subgroup,residual shunt,complications,operative time,ICU days staying in ICU and hospital,blood transfusion of the subgroup under different conclusion using the same treatment method,such as interventional therapy or surgical therapy were not significant.Conclusion(1)Transcatheter closure of secondum ASD with Amplatzer septal occluder is an efficient、safe method as surgical closure methods.(2)The former is better than the later in patients with various years and various sizes of ASD for its less trauma and complications and days both in ICU and in hospital if we master the indication rigidly.(3)There was no restricting of age and size in the superiority of interventional therapy.