CAJ | 학술논문

目的比较经胸微创封堵术与体外循环下外科治疗除干下型室间隔缺损以外的单纯室间隔缺损的效果.方法入选经超声心动图确诊为单纯室间隔缺损(非干下型)的患者220例.将患者分为两组,微创组(116例)采用经胸微创封堵术治疗,手术组(104例)采用传统的体外循环下手术治疗.收集患者术前及术后3、30、180 d的临床资料,比较两组的疗效.结果两组患者的年龄、性别、体质量和室间隔缺损类型差异均无统计学意义(P均＞0.05).微创组手术时间和住院时间均小于手术组(P均＜ 0.05).微创组术中输血的比例小于手术组[2.59％ (3/116)比72.12％(75/104),P＜0.01].术后3d,三尖瓣轻度及以上反流的比例小于手术组[0.86％(1/116)比2.88％(3/104),P＜0.05].微创组中,1例患者在术后30 d出现中量心包积液；手术组患者无心包积液.两组患者随访期间均无心内感染.术后30和180 d,微创组术后残余分流比例均小于手术组[1.72％(2/116)比7.69％(8/104)和0比7.69％(8/104),P均＜0.05].术后3、30、180 d,两组经胸超声心动图测量的各房室内径、左心室舒张末期容积指数和左心室射血分数差异均无统计学意义(P均＞0.05).结论经胸微创封堵术治疗除干下型室间隔缺损以外的单纯室间隔缺损具有与传统的体外循环下手术治疗相似的疗效,并且有手术时间和住院时间短,术中输血、术后发生三尖瓣反流和残余分流比例低的优点.
목적 비교경흉미창봉도술여체외순배하외과치료제간하형실간격결손이외적단순실간격결손적효과.방법 입선경초성심동도학진위단순실간격결손(비간하형)적환자220례.장환자분위량조,미창조(116례)채용경흉미창봉도술치료,수술조(104례)채용전통적체외순배하수술치료.수집환자술전급술후3、30、180 d적림상자료,비교량조적료효.결과 량조환자적년령、성별、체질량화실간격결손류형차이균무통계학의의(P균＞0.05).미창조수술시간화주원시간균소우수술조(P균＜ 0.05).미창조술중수혈적비례소우수술조[2.59％ (3/116)비72.12％(75/104),P＜0.01].술후3d,삼첨판경도급이상반류적비례소우수술조[0.86％(1/116)비2.88％(3/104),P＜0.05].미창조중,1례환자재술후30 d출현중량심포적액；수술조환자무심포적액.량조환자수방기간균무심내감염.술후30화180 d,미창조술후잔여분류비례균소우수술조[1.72％(2/116)비7.69％(8/104)화0비7.69％(8/104),P균＜0.05].술후3、30、180 d,량조경흉초성심동도측량적각방실내경、좌심실서장말기용적지수화좌심실사혈분수차이균무통계학의의(P균＞0.05).결론 경흉미창봉도술치료제간하형실간격결손이외적단순실간격결손구유여전통적체외순배하수술치료상사적료효,병차유수술시간화주원시간단,술중수혈、술후발생삼첨판반류화잔여분류비례저적우점.
Objective To compare the efficacy between micro invasive occlusion procedure and extracorporeal circulation procedure for treating patients with simple ventricular septal defect.Methods Two hundred and twenty patients with simple ventricular septal defect (except subarterial ventricular septal defect) were randomly divided into micro invasive group (n =116) and traditional cardiopulmonary bypass surgery group (n =104).Clinical data were collected and compared at baseline and at 3,30 and 180 days after surgery.Results Age,gender,body weight and ventricular septal defect type were similar between the two groups (all P ＞ 0.05).Operation time and hospitalization duration were significantly shorter in the micro invasive group than the traditional cardiopulmonary bypass surgery group(all P ＜ 0.05).The proportion of blood transfusion was less in micro invasive group than the traditional cardiopulmonary bypass surgery group [2.59％ (3/116)vs.72.12％ (75/104),P ＜0.01].Three days after surgery,incidence of mild and above tricuspid insufficiency was less in micro invasive group than the traditional cardiopulmonary bypass surgery group [0.86％ (1/116) vs.2.88％ (3/104),P ＜ 0.05].There was one patient developed mild pericardial effusion at 30 days post surgery in micro invasive group.There was no intracardiac infection in the two groups during follow-up.At 30 and 180 days post surgery,incidence of residual shunt was also less in micro invasive group than the traditional cardiopulmonary bypass surgery group [1.72％ (2/116) vs.7.69 (8/104) and 0 (0/116) vs.7.69 (8/104),all P ＜ 0.05].After surgery for 3,30 and 180 days,transthoracic echocardiography derived chamber size,left ventricular end-diastolic volume index and leftventricular ejection fraction were similar between the two groups(all P ＞ 0.05).Conclusions The efficacy is similar for patients with simple ventricular septal defect (except subarterial ventricular septal defect) using micro invasive occlusion therapy or extracorporeal circulation surgery.Micro invasive occlusion procedure can shorten operation and hospitalization time,and reduce the need for blood transfusion and risk of developing procedural-related tricuspid insufficiency and post-procedural residual shunt.