经胸超声与经食管超声引导下经皮房间隔缺损封堵术的应用比较  

Comparison of Transthoracic and Transesophageal Ultrasound-guided Transcatheter Closure of Atrial Septal Defect

作　　者：钟晓娇 周翠翠[1] 吴澄[2] 黄智华[1] 黄志平[1] Zhong Xiaojiao;Zhou Cuicui;Wu Cheng;Huang Zhihua;Huang Zhiping(Department of Ultrasound,Ganzhou people's Hospital,Ganzhou,Jiangxi 341000,China)

机构地区：[1]赣州市人民医院超声科,江西省赣州市341000 [2]赣州市人民医院心胸外科,江西省赣州市341000

出　　处：《中国超声医学杂志》2019年第11期991-994,共4页Chinese Journal of Ultrasound in Medicine

基　　金：赣州市科学技术局赣州市指导性科技计划任务(No.GZ2017ZSF110)

摘　　要：目的比较单纯经胸超声(TTE)与单纯经食管超声(TEE)在房间隔缺损(ASD)封堵术中的应用效果。方法回顾本院收治的36例中央型ASD患者,按照手术引导方式不同,将患者分为两组。其中21例患者运用TTE引导(TTE组),15例患者运用TEE引导(TEE组),比较两组间临床治疗效果。结果两组均无死亡及并发症发生。TEE组成功13例(成功率87%);失败2例,为封堵器未能成功卡位,改为体外循环下ASD修补术;TTE组成功18例(成功率86%);失败3例,1例为缺损较小,TTE图像质量差,未能引导导丝通过ASD改为TEE引导下封堵成功,2例因缺损较大,封堵器卡位不牢,改为体外循环下ASD修补术。术后随访3~48个月,无残余分流及封堵伞移位。两组患者间ASD最大径、封堵伞型号及住院时间差异无统计学意义(P>0.05);TTE组手术室滞留时间(68.7±10.8)min及总费用(2.58±0.36)万元均小于TEE组(125.3±19.2)min和(2.94±0.77)万元,P<0.05。结论单纯TTE及TTE引导下经皮ASD封堵术同样安全、有效。TTE组比TEE组更有效的缩短患者手术室滞留时间、减少患者住院总费用。Objective To compare the effect of percutaneous transcatheter closure of atrial septal defect(ASD)guided by transthoracic ultrasound(TTE)and transesophageal ultrasound(TEE),in order to find a more minimally invasive and economical treatment for ASD.Methods From 36 patients with central type ASD who were treated by percutaneous transcatheter closure procedure.According to the operational surgical treatment schemes,we were divided them into two groups.Among them,21 patients were treated with transthoracic ultrasound-guided percutaneous atrial septal defect occlusion(TTE group)and 15 patients were treated with transesophageal ultrasound-guided percutaneous atrial septal defect occlusion(TEE group).To compare the clinical results between the two groups.Results There was no operative death,no vascular injury and complications in both groups.In TEE group,13 cares in group successfully treated with percutaneous transcatheter closure,and there were 2 failed cases transferred to repair under cardiopulmonary bypass(CPB)because of inexperience in early stages.In TTE group,there were 18 cases successfully occluded and 3 cases of failure.In the 3 case,1 patients who transferred to TEE guided because of the poor imaging of TTE images,2 patients in TTE group transferred to repair under CPB because of the huge ASD and difficult stuck of the occluder.Follow-ups were conducted by TTE at month 3 post-operation to month 48 post-operation,all 31 cases performed no residual shunts and no occluded umbrellas displacement.There was no significant difference age,in the maximum diameter of ASD,the type of occluded umbrella and the length of hospitalization between TEE groups and TTE group(P>0.05).The stay time in the operation room in TTE group(68.7±10.8)min was obviously shortened than in TEE group(125.3±19.2)min,P<0.05.The total cost of the TTE group(25.8±3.6)thousand yuan was significantly lower than TEE group(29.4±7.7)thousand yuan,P<0.05.Conclusions Percutaneous transcatheter closure of ASD guided by TTE and TEE is also safe and e

关 键 词：房间隔缺损 经皮封堵术 超声心动图 

分 类 号：R54[医药卫生—心血管疾病]