摘要
目的 总结外科微创一站式治疗继发孔房间隔缺损(atrial septal defect,ASD)的临床经验,并观察不同微创技术的早中期随访结果.方法 选择2004年10月至2012年10月在武汉亚洲心脏病医院行外科微创一站式治疗的ASD患者254例,男性85例,女性169例,中位年龄32岁(2~60岁),其中食管超声心动图引导下经皮导管封堵组(经皮封堵组)8例,非体外循环微创经胸封堵组(经胸封堵组)163例,胸腔镜辅助体外循环下修补组(胸腔镜组)83例,对比分析三组的临床资料及随访结果.结果 经皮封堵组、经胸封堵组和胸腔镜的手术成功率分别为100%、100%和97.59%.无围术期死亡,无严重并发症,无大量残余分流.胸腔镜组的术后出血量明显高于其他两组(均P<0.05).随访中位数114个月(54~156个月),1例二次手术.临床心功能Ⅰ~Ⅱ级.2例迟发性肺动脉高压.三组术后出现残余分流的比例无统计学差异(x2=0.335,P=0.563).结论 外科微创一站式治疗ASD安全有效,中期随访效果满意.
Objective To investigate the immediate to middle-term outcome of minimally invasive one-stop surgery for atrial septal defect, providing guidance for clinical practice. Methods 254 hospitalized cases that underwent minimally invasive one-stop surgery for atrial septal defect (ASD) from Oct. 2004 to Oct. 2012 were included in the study. Among them, 85 were male and the others were female. The median age at operation was 32 years old (range from 2 years to 60 years). 8 cases underwent transcatheter closure of ASD guided by TEE;163 cases underwent transthoracic occlusion surgery;and 83 underwent totally thoracoscopic surgery. Results The success rate of three groups were 100%,100%,97.59% respectively. There were no hospital deaths and severe complications. The post operation hemorrhage of totally thoracoscopic surgery group was much higher than the other two groups. At a median follow- up of 114 months (range from 54 to 156 months), the patients were alive and free from reoperation except one. All have normal ventricular function. There was no difference in residual shunt between different groups. Conclusions Minimally invasive one-stop surgery for ASD has a satisfactory early and middle-term outcome, and should be the first choice for treatment of this kind congenital heart disease.
作者
贺必辉
许铭
宋来春
王潇
金晶
陶凉
李晓勇
HE Bi-hui;XU Ming;SONG Lai-chun;WANG Xiao;JIN Jing;TAO Liang;LI Xiao-yong(Department of Cardiac Surgery,Wuhan Asia Heart Hospital,Wuhan 430022,China)
出处
《中国心血管病研究》
CAS
2019年第2期178-180,共3页
Chinese Journal of Cardiovascular Research
基金
武汉市卫计委医学科研项目(WX17B19).
关键词
先天性心脏病
房间隔缺损
微创
胸腔镜
Congenital heart disease
Atrial septal defect
Minimally invasive surgery
Thoracoscopy
