Chen Qiang, Cao Hua, Chen Zhao-Yang, Zhang Gui-Can, Chen Liang-Wan, Xu Fan, He Jia-Jun
Department of Cardiovascular Surgery Department of Cardiology, Union Hospital, Fujian Medical University, Fuzhou, P. R. China.
Medicine (Baltimore). 2017 Mar;96(11):e6316. doi: 10.1097/MD.0000000000006316.
The purpose of this study was to compare patient populations, safety, feasibility, complications, and total costs of the transcatheter and transthoracic device closure treatments for secundum atrial septal defect.From January 2014 to December 2014, we enrolled 155 patients with secundum atrial septal defects in our hospital. The patients were divided into 2 groups: the 70 patients in group A underwent transcatheter device closure, and the 85 patients in group B underwent transthoracic intraoperative device closure with a right lateral mini-thoracotomy.In group A, the total occlusion rate was 94.3% immediately after the operation, 100% at 3 months, and 100% at 12 months of follow-up; the group A results were not statistically different from the group B results (94.1%, 98.8%, 98.8%, respectively). There was a statistically significant difference in the minor complication rate (P < 0.05), and there were no reported deaths. There was a greater indicated scope using the transthoracic closure device to treat atrial septal defects. In our comparative study, the patients in group B had longer intensive care unit stays and hospital stays than group A (P < 0.05).Both of the device closure treatment options for secundum atrial septal defect are safe and feasible. The transcatheter device closure approach has the advantages of more cosmetic results, less trauma, and a shorter hospital stay than the transthoracic approach. On the contrary, the transthoracic closure device is an economical alternative choice, particularly for patients who are not eligible for the transcatheter closure device.
本研究的目的是比较继发孔型房间隔缺损经导管封堵治疗与经胸封堵治疗的患者人群、安全性、可行性、并发症及总成本。2014年1月至2014年12月，我院纳入155例继发孔型房间隔缺损患者。患者分为2组：A组70例患者接受经导管封堵治疗，B组85例患者经右侧微创胸廓切开术在术中接受经胸封堵治疗。A组术后即刻总封堵率为94.3%，3个月时为100%，随访12个月时为100%；A组结果与B组结果（分别为94.1%、98.8%、98.8%）无统计学差异。轻微并发症发生率有统计学差异（P<0.05），无死亡报告。经胸封堵装置治疗房间隔缺损的适应证范围更广。在我们的对比研究中，B组患者的重症监护病房住院时间和住院时间均长于A组（P<0.05）。继发孔型房间隔缺损的两种封堵治疗方案均安全可行。与经胸封堵方法相比，经导管封堵方法具有美容效果更好、创伤更小、住院时间更短的优点。相反，经胸封堵装置是一种经济的替代选择，尤其适用于不符合经导管封堵装置适应证的患者。
