经胸微创切口术中器械闭合房间隔缺损的安全性和可行性。
Safety and feasibility of intra-operative device closure of atrial septal defect with transthoracic minimal invasion.
机构信息
Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, PR China.
出版信息
Eur J Cardiothorac Surg. 2012 Jan;41(1):121-5. doi: 10.1016/j.ejcts.2011.04.001.
OBJECTIVE
The study aims to evaluate the safety and feasibility of intra-operative device closure of atrial septal defect with transthoracic minimal invasion.
METHODS
From May 2006 to June 2009, 252 patients with secundum-type atrial septal defect closure were enrolled in our institution. The patients were divided into two groups, with 182 patients in group I with intra-operative device closure and 72 in group II with surgical closure. In group I, the patients' age ranged from 3 months to 62 years (mean±standard deviation, 19.0±16.7 years). This approach involved a transthoracic minimal invasion that was performed after full evaluation of the atrial septal defect by transthoracic echocardiography, deploying the device through the delivery sheath to occlude the atrial septal defect.
RESULTS
In group I, 180 patients were occluded successfully under this approach. The size of the occluder device implanted ranged from 6 to 48 mm. Minor complications occurred, which included transient arrhythmias (n=23) and pleural effusion (n=15). Two patients with postoperative cardiac arrest were successfully cardiopulmonary resuscitated. Another two patients with occluder dislodged back into the right atrium were turned to surgical repair with cardiopulmonary bypass on the postoperative day. In group II, all patients were occluded successfully, and almost all patients needed blood transfusion and suffered from various minor complications. All discharged patients were followed up for 1-5 years. During this period, we found no recurrence, no thrombosis, even no device failure. In our comparative studies, group II had significantly longer intensive care unit (ICU) stay and hospital stay than group I (p<0.05). The cost for group I was less than group II (p<0.05).
CONCLUSIONS
Intra-operative device closure of atrial septal defect with transthoracic minimal invasion is a safe and feasible technique. It had the advantages of cost savings, yielding better cosmetic results, and leaving less trauma than surgical closure.
目的
本研究旨在评估经胸微创术中应用器械闭合房间隔缺损的安全性和可行性。
方法
2006 年 5 月至 2009 年 6 月，我院共收治 252 例继发孔型房间隔缺损患者。将患者分为两组，其中 182 例行术中器械闭合（I 组），72 例行外科手术闭合（II 组）。I 组患者年龄 3 个月至 62 岁，平均（19.0±16.7）岁。经胸超声心动图充分评估房间隔缺损后，采用经胸微创方法，通过输送鞘管释放器械闭合房间隔缺损。
结果
I 组 180 例患者成功接受了该方法治疗。植入的封堵器大小为 6-48mm。术后出现轻微并发症，包括短暂性心律失常（23 例）和胸腔积液（15 例）。2 例术后心跳骤停患者经心肺复苏成功。另外 2 例封堵器脱落回右心房的患者术后第 2 天行体外循环下修补术。II 组患者均成功闭合，几乎所有患者均需输血，并出现各种轻微并发症。所有出院患者均随访 1-5 年。在此期间，我们未发现复发、血栓形成，甚至封堵器失效。在我们的对比研究中，II 组 ICU 住院时间和住院时间明显长于 I 组（p<0.05）。I 组的费用低于 II 组（p<0.05）。
结论
经胸微创术中应用器械闭合房间隔缺损是一种安全可行的技术。与外科手术闭合相比，它具有节省成本、美容效果更好、创伤更小的优点。
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