微创小切口手术修补与介入封堵治疗单纯继发孔型房间隔缺损  

Minimally invasive small incision surgical repair versus interventional device closure for secundum atrial septal defects

作　　者：胡友洋[1] 严中亚[1] 吴一军[1] 卢中[1] 雷虹[1] 徐健[2] 孙云[1] 郑理[1] 陈鸿武[2] 

机构地区：[1]安徽医科大学附属安徽省立医院心脏外科,合肥230001 [2]安徽医科大学附属安徽省立医院心血管内科,合肥230001

出　　处：《中国微创外科杂志》2007年第5期400-402,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的比较微创小切口手术修补与介入封堵治疗房间隔缺损(atrial septal defect,ASD)的优缺点。方法回顾分析2004年1月～2006年6月采用微创方法治疗单纯继发孔型ASD69例资料,其中行小切口心脏不停跳下手术修补37例(小切口组),行介入封堵32例(介入组)。结果两组均无死亡病例。小切口组37例手术全部成功,手术时间(145.86±27.84)min,体外循环时间(35.11±8.45)min,住院时间(15.46±3.09)d,发生主要并发症2例、次要并发症6例,住院费用(2.19±0.36)万元。介入组2例封堵失败,余30例成功,手术时间(88.59±7.75)min,住院时间(10.81±5.02)d,发生主要并发症1例、次要并发症2例,住院费用(2.78±0.39)万元。小切口组随访3～12个月20例、12～30个月17例,介入组随访3～12个月16例、12～30个月14例,均无残余分流。结论两种微创方法均可安全有效地用于单纯继发孔型ASD的治疗,微创小切口方法的费用低,成功率高,适应证广,而介入封堵方法的住院时间短,创伤更小,美容效果更好。Objective To compare merits and shortages between minimally invasive small incision surgical repair and interventional device closure for isolated secundum atrial septal defect （ ASD）. Methods A retrospective analysis was made on clinical results of 69 patients with isolated secundum ASD from January 2004 to June 2006. Among them 37 patients underwent minimally invasive small incision surgical repair on the beating heart （ Small Incision Group） and 32 patients underwent interventional device closure of ASD （Interventional Group）. Results There were no deaths in either group. The small incision surgical repair was successfully completed in all the 37 patients, with the procedure time, cardiopulmonary bypass time, and hospital stay being 145.86 ± 27.84 min, 35.11 ± 8.45 min, and 15.46 ± 3.09 d, respectively. Major and minor complications occurred in 2 and 6 patients, respectively. The hospitalization costs was 21 900 ± 3600 yuan. In the Interventional Group, the closure was successfully performed in 30 out of 32 patients. The procedure time and hospital stay were 88.59 ± 7.75 min and 10.81 ± 5.02 d, respectively. Major and minor complications occurred in 1 and 2 patients, respectively. The hospitalization costs was 27 800 ± 3900 yuan. Follow-up observations were performed in the Small Incision Group for 3 - 12 months in 20 patients and for 12 - 30 months in 17 patients, and in the Interventional Group for 3 - 12 months in 16 patients and for 12 - 30 months in 14 patients. No residual shunt was found. Conclusions Both of minimally invasive methods are safe and effective for isolated secundum ASD. Small incision surgical repair involves lower costs, higher successful rate, and broader indications, whereas interventional device closure offers shorter hospital stay, milder trauma, and better cosmetic results.

关 键 词：微创小切口 介入封堵 房间隔缺损 

分 类 号：R654.2[医药卫生—外科学]