CAJ | 학술논문

目的比较单纯食管超声(TEE)引导下经皮和经胸封堵继发房间隔缺损(ASD)的临床结果.方法 53例ASD直径25 mm的患者行单纯TEE引导下经皮ASD封堵术(经皮组),另50例同期经胸微创封堵ASD的患者作为对照(经胸组).对比两组的手术成功率、心内操作时间、手术时间、住院时间和近中期随访结果.结果两组ASD直径＜20 mm患者的封堵成功率均为100％;ASD直径20 mm患者的成功率,经皮组84％,经胸组100％.3例ASD 20 mm且主动脉瓣侧边缘3 mm的患者经皮封堵失败,改经胸封堵成功.心内操作时间经皮组(20±7) min,经胸组(5±6) min.手术时间经皮组(24±7) min,经胸组(39±6) min.术后住院时间经皮组(3.0±0.8)天,经胸组(4.7±1.5)天.结论单纯TEE引导下经皮封堵直径25 mm的ASD安全、可行,创伤更小,更美观,患者住院时间更短.对于大型ASD,经胸封堵更可靠.
목적 비교단순식관초성(TEE)인도하경피화경흉봉도계발방간격결손(ASD)적림상결과.방법 53례ASD직경25 mm적환자행단순TEE인도하경피ASD봉도술(경피조),령50례동기경흉미창봉도ASD적환자작위대조(경흉조).대비량조적수술성공솔、심내조작시간、수술시간、주원시간화근중기수방결과.결과 량조ASD직경＜20 mm환자적봉도성공솔균위100％;ASD직경20 mm환자적성공솔,경피조84％,경흉조100％.3례ASD 20 mm차주동맥판측변연3 mm적환자경피봉도실패,개경흉봉도성공.심내조작시간경피조(20±7) min,경흉조(5±6) min.수술시간경피조(24±7) min,경흉조(39±6) min.술후주원시간경피조(3.0±0.8)천,경흉조(4.7±1.5)천.결론 단순TEE인도하경피봉도직경25 mm적ASD안전、가행,창상경소,경미관,환자주원시간경단.대우대형ASD,경흉봉도경가고.
Objective This study is to evaluate the advantages between percutaneous and peratrial device closure of secundum atrial septal defects(ASD) under single transesophageal echocardiographic (TEE) guidance.Methods From December 2010 to December 2012,53 patients with the ASD of≤25 mm in diameter underwent percutaneous device closure under simple TEE guidance(the percutaneous group).The device was implanted through the femoral vascular access.Fifty patients with similar age and similar-sized ASD to the percutaneous group,were selected from 350 consecutive patients who underwent peratrial device closure of ASD and assigned to the peratrial group.The ASDs were occluded through a right minithoracotomy approach.The success rate,intracardiac manipulation time,procedural time,postoperative stay and the follow-up results were recorded.Results When the maximum diameter of ASD was ＜ 20 mm,the success rate of both groups was 100％.When the ASD diameter was 20 mm but 25 mm,the success rate was 84％ in the percutaneous group and 100％ in the peratrial group.Three patients failed in the percutaneous group with the ASD diameter of 20 mm and the aortic rim of 3 mm.They were successfully converted to peratrial device closure.The average intrcardiac manipulation time was(20±7) minutes in the percutaneous group and (5 ± 6) minutes in the peratrial group(P ＜ 0.05).The average procedure time was(24 ± 7) minutes in the percutaneous group and (39 ± 6) minutes in the peratrial group(P ＜ 0.05).The postoperative hospital stay was (3.0 ± 0.8) days in the percutaneous group and(4.7 ± 1.5) days in the peratrial group(P ＜ 0.05).Conclusion The percutaneous device closure of ASD under simple TEE guidance is feasible,safe,and efficacious in patients with the ASD diameter of ≤25 mm.It has the advantages of less trauma,less procedural time,shorter hospital stay and better cosmetic results.However,when the ASD diameter was 20 mm and the aortic rim was 3 mm,the peratrial approach may be a better choice.