经胸超声与经食管超声引导下经皮房间隔缺损封堵术的比较研究  

Percutaneous transcatheter closure of atrial septal defect： guided by transthoracic echocardiogram vs transesophageal echocardiogram

作　　者：窦志[1] 谢琦[1] 翁国星[1] 赖宝春[1] 戴莹[1] 叶振盛[1] 陈智群[1] 王韧[1] 鲍家银[1] 王欢[1] 肖荣冬[1] Dou Zhi;Xie Qi;Weng Guoxing;Lai Baochun;Dai Ying;Ye Zhensheng;Chen Zhiqun;Wang Ren;Bao Jiayin;Wang Huan;Xiao Rongdong(Department of Cardiovascular Surgery,Fujian Provincial Hospital,Fuzhou 350001,China)

机构地区：[1]福建省立医院心外二科,福州350001

出　　处：《中华胸心血管外科杂志》2018年第9期522-526,共5页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的比较经胸超声（TTE）与经食管超声（TEE）在房间隔缺损（ASD）封堵术中的应用结果，探讨更加微创、经济的ASD治疗方法。方法回顾2014年3月至2017年9月197例继发孔中央型ASD患者资料，术前TTE检查评估适合行完全超声引导下封堵术。106例采用全身麻醉下TEE引导下经皮ASD封堵术，男47例，女59例；年龄（14.2±16.1）岁，体质量（29.5±18.9）kg；ASD最大径（16.2±8.1）mm。91例采用局部麻醉（12岁以内患儿为全身麻醉无插管监护）完全TTE引导下ASD封堵术，男41例，女50例；年龄（13.8±15.6）岁，体质量（30.4±19.5）kg；ASD最大径（15.6±7.3）mm。收集患者术中、术后资料。结果无手术死亡，无相关损伤性并发症。TEE组封堵伞型号（21.1±8.9）mm，成功102例（96.2%）；失败4例，其中1例中转经胸小切口封堵，3例改行体外循环修补术。TTE组封堵伞型号（20.3±8.1）mm，成功86例（94.5%）；失败5例，其中2例改行经TEE引导成功完成经皮封堵，2例改行经胸封堵，1例中转体外循环修补。术后随访3-48个月，无封堵伞移位发生。两组ASD患者年龄、体质量、ASD最大径及封堵伞型号差异无统计学意义（P〉0.05）；TTE组手术室停留时间及总费用[（34.7±16.8）min和（2.42±0.21）万元]均小于TEE组[（68.2±17.3）min和（2.93±0.14）万元]，P〈0.01。结论TTE引导下经皮ASD封堵术安全、有效，更加无创及经济。ObjectiveTo explore a more minimally invasive and economical treatment for atrial septal defect（ASD） through comparing the efficacy and safety in percutaneous transcatheter closure of atrial septal defect procedure, guided by transthoracic echocardiography（TTE） and transesophageal echocardiography（TEE） .MethodsFrom March 2014 to September 2017, 197 patients with ASD who were feasible to treated with percutaneous transcatheter closure procedure evaluated by preoperative TTE were recruited. TTE showed ASD belonged to secundum（central type） with a maximal diameter range from 2 mm to 35mm, including 82 cases of the ASD without aortic rim.There were 106 patients（47males and 59 females including 37 ASD without aortic rim） with a mean age of 14.2 years（6 months-59 years） old and a mean body weight of 29.5（8.5-64.0）kg were performed percutaneous transcatheter closure of ASD guided by TEE under general anesthesia and endotracheal intubation, and 91 patients（41males and 50 females with 45 ASD without aortic rim inside） with a mean age of 13.8 years（9 months-65 years） old and a mean body weight of 30.4（9.5-61.0）kg were treated with the percutaneous transcatheter procedure guided by TTE when patients in waking state of local anesthesia（general anesthesia were adopted in patients under 12 years old without intubation）. The size of the occluder was selected on the basis of the maximal diameter plus 2-6mm. All 197 cases intraoperation and postoperation data were collected, including complications、operation time、operation room stay time and total cost.Results1 patients in 106 cases of the the TEE group were transferred to small incision on the chest performing transthoracic transcatheter closure of ASD because the difficult stuck of the occluder. 3 patients in TEE group transferred to repair under cardiopulmonary bypass（CPB） via small incision on the chest because the difficult stuck of the occluder even in using transthoracic transcatheter closure way. 86 patiens in TTE group

关 键 词：房间隔缺损 微创 封堵 

分 类 号：R654.2[医药卫生—外科学]