三种不同微创技术与经典外科技术治疗房间隔缺损的临床对比研究  

Three Kinds of Minimally Invasive Procedures Versus Clasical Surgical in the Treatment of Atrial Septal Defect:The Comparative Study of Clinical Outcome

作　　者：李巅远[1] 闫军[1] 李守军[1] 晏馥霞[2] 李立环[2] 魏以桢[1] 郑哲[1] 刘志刚[1] 崔彬[1] 陶天富[1] 胡盛寿[1] 

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心外科,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麻醉科,北京100037

出　　处：《中国胸心血管外科临床杂志》2009年第1期31-35,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：十一五国家科技支撑计划资助项目(2006BA101A08);中央级公益性科研院所基本科研业务费专项资金(2007F005)~~

摘　　要：目的为了更好地治疗房间隔缺损(ASD),探讨经典外科技术及三种不同的微创介入技术治疗ASD的优缺点。方法2007年6月至2008年3月,阜外心血管病医院分别采用经典外科手术(n=301)、经皮介入封堵术(n=274)、开胸Hybrid术(n=50)和非气管内插管下胸膜外Hybrid术(非气管插管下Hybrid术,n=27)治疗单纯ASD 652例。按照上述治疗技术将患者分为4组,对比分析4组患者年龄、住院时间、创伤、住院费用、输血、麻醉、气管内插管和术后随访等指标。结果开胸Hybrid术组和非气管插管下Hybrid术组中年龄和体重显著小于其他2组(P<0.01)。4组手术成功率分别为100.0%,97.2%,92.6%和100.0%,组间比较差异有统计学意义(P<0.01)。经皮介入封堵术组和非气管插管下Hybrid术组住院天数和输血费用显著短于/少于其他2组(P<0.01)。4组住院费用分别为24 802.90±360.96元,25 095.07±437.13元,24 856.77±445.87元和24 853.56±673.99元,差异无统计学意义(P>0.05)。4组患者均康复出院,术后随访时间分别为4.64±0.32月,4.57±0.31月,4.49±0.28月和4.62±0.31月,差异无统计学意义(P>0.05);术后切口并发症发生率分别为3.32%,0.47%,6.00%和0.00%,经皮介入封堵术组和非气管插管下Hybrid术组显著低于其他2组(P<0.01)。结论4种治疗方法的费用大致相同,经典外科手术成功率最高,可适用于任何年龄的ASD患者,但创伤最大;经皮介入封堵术创伤最小,但应用于低体重、低年龄婴幼儿ASD患者存在局限性;开胸Hybrid手术可适用于任何年龄的患者,不需要体外循环,创伤明显减小,但仍存在一定的外科损伤;非气管插管下胸膜外Hybrid术可适用于任何年龄患者,且医疗费用并不高于经典外科技术和经皮介入治疗技术,手术成功率高,术后并发症少,尤其是针对低体重、低年龄的婴幼儿患者,是一种较为理想的手术方法。Objective To therapy the atrial septal defect（ASD） much more better, comparative study of clinical outcomes in surgical treatment of ASD to other three minimally invasive procedures was performed. Methods From June 2007 to March 2008, 652 ASD patients had undergone surgery（n= 301）, transcatheter closure （n=274）, openchest Hybrid closure（n= 50） and without tracheal intubation Hybrid closure （n = 27） of ASD. Patients were and divided into four groups according to the different procedures. Retrospectively we compared the data of patient＇s age, hospital stay, trauma, cost of hospitalization, blood transfusion, anesthesia, tracheal intubation and post-operative fellow-up. Results Median age and weight of open-chest Hybrid and without tracheal intubation Hybrid groups were significantly less than those of the other two groups （P〈0.01）. The achievement ratio of four groups were 100.0%, 97.2%, 92. 6%, 100.0%. There was statistically difference in the achievement ratio of four groups （P〈0.01）. Median hospital stay and cost of blood transfusion of transcatheter closure and without tracheal intubation Hybrid groups were significantly less than other two groups （P〈0. 01）. The mean cost of hospitalization in four groups were 24 802.90±360. 96￥ ,25 095.07±437. 13￥,24 856.77±445. 87￥,24 85a. 56±673. 99￥ respectively. There was no statistically difference in the cost of hospitalization（P〉0.05）. All patients were recovered and discharged without eventuality. The mean follow-up time were 4.64±0.32 month,4.57±0.31 month,4.49±0.28 month,4.62±0.31 month. There was no statistically difference in the follow-up time （P〉0.05）. The complication rate of post-operative incision were 3. 32%, 0. 47%, 6. 00%, 0.00%. The transcatheter closure and without tracheal intubation Hybrid groups were significantly less than other two groups （P〈0.01）. Conclusions The mean cost of hospitalization in four procedure were almost the same. The ability to close any ASD regardless of its

关 键 词：先天性心脏病 房间隔缺损 Hybrid手术 

分 类 号：R541.1[医药卫生—心血管疾病]