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目的比较心健TM封堵器介入治疗与外科手术治疗房间隔缺损和动脉导管未闭的可行性、安全性及疗效。方法介入组应用心健TM封堵器介入治疗房间隔缺损29例,均为继发孔中央型;治疗动脉导管未闭23例,其中漏斗型9例、管型13例、窗型1例。介入病人在X线透视及经胸超声心动图监视下,按照常规方法行封堵术。同期外科手术治疗房间隔缺损41例,其中继发孔中央型5例、上腔型22例、下腔型12例、筛孔型2例;动脉导管未闭36例,其中漏斗型9例,管型27例。房间隔缺损外科修补术分别采用右前外侧小切口10例、胸腔镜下25例、正中切口11例;动脉导管未闭均采用左后外侧切口结扎术。结果全部病例无死亡。介入组即刻成功率98%(51/52),即刻完全封堵率96%(49/51);窗形动脉导管未闭并重度肺动脉高压1例,在术后有残余分流并血尿,另术后早期有少量残余分流1例,Ⅰ度房室传导阻滞4例,随访1个月～6个月症状均消失。外科组动脉导管未闭1例,在术中有大出血;ASD1例,术后有大量残余分流;动脉导管未闭3例,术后有极少量残余分流;心房扑动和肺不张各1例、胸腔积液4例、心包积液2例、切口感染1例。结论介入与外科手术治疗房间隔缺损和动脉导管未闭的成功率无明显差别,介入治疗与外科治疗比较,并发症发生差异无统计学意义,病人创伤少,痛苦轻,住院时间短,但费用偏高,非适应证的病人仍需手术治疗。
Objective To compare the feasibility, safety and efficacy of Cardiac TM occluder interventional therapy and surgical treatment of atrial septal defect and patent ductus arteriosus. Methods Thirty-two patients with atrial septal defect were involved in the interventional therapy of atrial septal defect using the heart-health TM occluder. Twenty-three patients were treated with patent ductus arteriosus, including 9 funnels, 13 tubes and 1 window. Interventional patients under X-ray and transthoracic echocardiography monitoring, in accordance with the conventional method of occlusion. In the same period, 41 cases were treated by surgical operation, including 5 cases of secondary central hole, 22 cases of superior cavity, 12 cases of inferior cavity and 2 cases of mesh, 36 cases of patent ductus arteriosus, 9 cases of funnel, Tube type in 27 cases. Surgical repair of atrial septal defect using 10 cases of small anterolateral anterolateral incision, thoracoscopy in 25 cases, 11 cases of median incision; patent ductus arteriosus were left lateral incision ligation. Results no deaths in all cases. Immediate success rate was 98% (51/52) in the intervention group and 96% (49/51) in the immediately complete occlusion group. One case of patent ductus arteriosus and severe pulmonary hypertension had residual shunt and hematuria after operation. After a small amount of residual shunt in early cases, Ⅰ degree atrioventricular block in 4 cases, followed up for 1 month to 6 months symptoms disappeared. There were 1 case of patent ductus arteriosus in surgical group with major hemorrhage during operation; 1 case of ASD had a large residual shunt after operation; 3 cases of patent ductus arteriosus and a very small residual shunt after operation; 1 case of atrial flutter and atelectasis , Pleural effusion in 4 cases, pericardial effusion in 2 cases, incision infection in 1 case. Conclusion There is no significant difference in the success rate between interventional and surgical treatment of atrial septal defect and patent ductus arteriosus. There is no significant difference in the incidence of complications between interventional treatment and surgical treatment. The patient has less trauma, less pain and shorter hospital stay but costs High, non-indications of patients still need surgery.