介入治疗和外科治疗房间隔缺损的对比研究

目的以18周岁为年龄分界、以20mm为房间隔缺损（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2005年1月—2008年12月,既适宜行封堵术也可行外科手术治疗的299例继发孔型ASD患者,按照其年龄及房间隔缺损大小分为4组：未成年小房缺组,未成年大房缺组和成年小房缺组、成年大房缺组。其中,每组又各自按治疗方法分为介入亚组及外科亚组。分别比较每组条件下不同亚组的技术成功率、并发症、残余分流、手术时间、重症监护病房（ICU）天数、住院天数、输血量等。结果4组中每2个对应的亚组在技术成功率和残余分流率方面差异无统计学意义。2组均无死亡病例,但外科亚组并发症发生率和输血量方面高于介入组,ICU时间及住院时间和操作时间方面均长于介入组。结论2种治疗方法均安全有效。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。

Comparative Study on Interventional Therapy and Surgical Therapy for Atrial Septal Defect

Objective ] To compare the safety and efficacy of transcatheter occlusion and surgical therapy for atrial septal defect （ASD） , taking 18-year-old as age boundaries and 20mm as size boundaries. Methods] During January 2005 - December 2008, a total of 299 patients with secundum ASD who were suitable for both transcatheter occlusion and surgical therapy were divided into 4 groups （ adolescent small ASD group, adolescent large ASD group, adult small ASD group, adult large ASD group） based on the age and the size of ASD. Among which each group was divided into intervention subgroup and surgery subgroup. Technical success rate, complications, residual shunt, operative time, intensive care unit（ ICU） staying days, hospitalization days and blood transfusion, etc of each subgroup in every group were compared. Results ] The differences of technical success rate and residual shunt of each subgroup in every group were not significant. There was no death case in each subgroup, but the incidence of complications and blood transfusion volume of surgery subgroup were higher than those of intervention subgroup, ICU staying days and hospitalization days were longer than those of intervention subgroup. Conclusion ] Both 2 therapies were safe and effective. For ASD patients with different ages and different size, as long as a reasonable selection of indication, the intervention therapy is more superior because of its characteristic of micro - trauma.