继发孔型房间隔缺损介入治疗和外科手术的对比分析  

Comparison of efficacy and cost between transcatheter and surgical closure of secundum atrial septal defect

作　　者：杨振文[1] 戴汝平[1] 张戈军[1] 徐仲英[1] 蒋世良[1] 胡盛寿[2] 

机构地区：[1]中国医学科学院中国协和医科大学阜外心血管病医院放射科,北京100037 [2]中国医学科学院中国协和医科大学阜外心血管病医院心外科,北京100037

出　　处：《中华心血管病杂志》2004年第5期390-393,共4页Chinese Journal of Cardiology

摘　　要：目的　对比分析Amplatzer封堵器介入治疗和外科手术治疗继发孔型房间隔缺损(ASD)的疗效、安全性和费用。方法　应用回顾性研究方法 ,选择符合入选标准的继发孔型房间隔缺损患者 2 73例 ,其中外科手术组 15 9例 ,介入治疗组 114例。外科手术组和介入治疗组年龄分别为(2 0 7± 15 1)岁和 (2 5 4± 16 1)岁 (P =0 0 13) ,ASD大小分别为 (18 9± 6 1)mm和 (16 5± 5 0 )mm(P =0 0 1)。结果　介入治疗组和外科手术组的成功率分别为 96 9%和 10 0 % (P =0 0 0 7) ,残余分流率分别为 2 7%和 1 2 % (P =0 5 0 5 ) ,介入治疗组的总并发症发生率、主要并发症发生率、次要并发症发生率均低于外科手术组 (P <0 0 5 )。介入治疗组中无一例患者需要输血 ,而外科手术组中 6 6例患者需要输血 ,平均输血量为 (5 77± 191)ml。相关分析表明 ,年龄越小 ,输血量越多 (r =0 5 73)。介入治疗组的治疗费用显著高于外科手术组 ,两组分别为 (44 188 38± 3189 35 )元和(2 0 6 87 92± 4 80 7 95 )元 (P <0 0 0 5 )。介入治疗组和外科手术组的住院天数分别为 (2 87± 1 82 )d和 (12 91± 3 74 )d(P <0 0 0 5 )。结论　介入治疗的成功率稍低于外科手术 ,但两组残余分流率相同。介入?Objective To compare the efficacy, safety and cost between Amplatzer occluder and surgical closure of secundum atrial septal defect. Methods According to the same inclusion criteria, 273 patients with secundum atrial septal defect were treated by surgical closure (159 cases) or transcatheter closure with Amplatzer occluder (114 cases). In surgery group, there were 51 male patients, 118 female patients with median age of (20.7±15.1) years old. In transcatheter closure group, there were 46 male patients, 68 female patients with median age of (25.4±16.1) years old. The median sizes of atrial septal defect of surgery group and transcatheter closure group were (18.9±6.1) mm and (16.5±5.0) mm respectively( P =0.01). Results The procedural attempt successful rate was 100% for surgery group and 96.9% for transcatheter closure group ( P =0.007). Residual shunt rates of surgery group and transcatheter closure group were 1.2% and 2.7% respectively( P >0.05). Total complication rates of surgery group and transcatheter closure group were 15.1% and 2.7% respectively ( P <0.05), major complication rates of each group were 2.5% and 0 respectively ( P <0.05), minor complication rates of each group were 13.2% and 2.7% respectively ( P <0.05). No patient need blood transfusion in transcatheter closure group whereas 66 patients accepted blood transfusion of mean volume (577±191) ml. There was a significant negative linear correlation between age and blood transfusion volume ( r =0.573, P <0.05) in surgery group. The costs of surgery group and transcatheter closure group were (20 687.92±4807.95) RMB and (44 188.38±3 189.35) RMB, respectively( P <0.005). The mean lengths of hospital stay were (2.87±1.82) days and (12.9± 3.74) days, respectively( P <0.005). Conclusion Although the procedural ttempt successful rate of transcatheter closure group was lower than that of surgery group, the residual shunt rates of both groups were similar. In the transcatheter closure group, which no patient need blood transfusion with shorter hos

关 键 词：介入治疗 外科手术 患者 继发孔型房间隔缺损 并发症发生率 输血量 ASD 大小 成功率 

分 类 号：R541.1[医药卫生—心血管疾病]