两种不同路径介入封堵房间隔缺损的临床对比研究
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摘要
目的:比较经胸壁打孔路径和经心导管路径介入封堵单纯继发孔型房间隔缺损(Atrial septal defect,ASD)的优缺点及适应证。
方法回顾分析2004年9月~2007年3月采用介入封堵治疗单纯继发孔型ASD患者41例,其中经胸壁打孔路径12例(胸壁打孔组),经心导管路径29例(心导管组)。
结果两组均无死亡病例,均不需要输血。胸壁打孔组12例手术全部成功,心导管组29例中,手术成功26例,失败3例(包括1例术中封堵器脱落转外科急诊手术)。两组手术时间和封堵器平均释放次数分别是76.25±20.24 VS 92.56±34.18 min和1.0 VS 1.48±0.95次,相比差异有显著性意义(P<0.05)。心导管组发生主要并发症2例,而胸壁打孔组无1例发生主要并发症。两组随访时间1个月~30个月,均无残余分流和封堵器移位。
结论经胸壁打孔路径和经心导管路径介入封堵单纯继发孔型ASD均具有创伤小、术后恢复快、美容效果好等优点。心导管路径的手术成功率略低,适应证相对狭窄,技术操作难度大;胸壁打孔路径的适应证相对较广,技术简单,手术成功率及安全性更高。
Objective To compare the merit and shortage of interventional device closure of isolated secundum atrial septal defects(ASD) through cardiac catheter or chest small incision .
Methods Retrospective analyses of the clinical results of interventional device closure of isolated secundum ASD through cardiac catheter or chest small incision for 41 patients from September 2004 to March 2007 was performed . Among them 12 patients underwent device closure of ASD through chest small incision (chest small incision group) and 29 patients underwent device closure of ASD through cardiac catheter (cardiac catheter group).
Results There were no deaths and blood transfusion in either group . Interventional device closure through chest small incision was successful in all 12 patients , while interventional device closure through cardiac catheter was successful in 26 of 29 cases. The mean procedure time of chest small incision group was significantly shorter than that of cardiac catheter group (76.25±20.24 VS 92.56±34.18 min, P<0.05). The mean occluder delivery times of chest small incision group was less than that of cardiac catheter group (1.0 VS 1.48±0.95 times , P<0.05). Two major complications occurred in cardiac catheter group , but no one occurred in chest small incision group . Forty-one patients were followed-up from 1 months to 30 months , all of patients were free from residual leak and occluder dislodgment.
Conclusion Both paths can achieve secure occlusion for isolated secundum ASD with mild trauma and fast postoperative recovery and good cosmetic result. Interventional device closure of ASD through cardiac catheter involves slightly low success rate and relatively narrow indication and difficult technique whereas through chest small incision offers relatively wider indication and simple technique and higher success rate or safety.
方法回顾分析2004年9月~2007年3月采用介入封堵治疗单纯继发孔型ASD患者41例,其中经胸壁打孔路径12例(胸壁打孔组),经心导管路径29例(心导管组)。
结果两组均无死亡病例,均不需要输血。胸壁打孔组12例手术全部成功,心导管组29例中,手术成功26例,失败3例(包括1例术中封堵器脱落转外科急诊手术)。两组手术时间和封堵器平均释放次数分别是76.25±20.24 VS 92.56±34.18 min和1.0 VS 1.48±0.95次,相比差异有显著性意义(P<0.05)。心导管组发生主要并发症2例,而胸壁打孔组无1例发生主要并发症。两组随访时间1个月~30个月,均无残余分流和封堵器移位。
结论经胸壁打孔路径和经心导管路径介入封堵单纯继发孔型ASD均具有创伤小、术后恢复快、美容效果好等优点。心导管路径的手术成功率略低,适应证相对狭窄,技术操作难度大;胸壁打孔路径的适应证相对较广,技术简单,手术成功率及安全性更高。
Objective To compare the merit and shortage of interventional device closure of isolated secundum atrial septal defects(ASD) through cardiac catheter or chest small incision .
Methods Retrospective analyses of the clinical results of interventional device closure of isolated secundum ASD through cardiac catheter or chest small incision for 41 patients from September 2004 to March 2007 was performed . Among them 12 patients underwent device closure of ASD through chest small incision (chest small incision group) and 29 patients underwent device closure of ASD through cardiac catheter (cardiac catheter group).
Results There were no deaths and blood transfusion in either group . Interventional device closure through chest small incision was successful in all 12 patients , while interventional device closure through cardiac catheter was successful in 26 of 29 cases. The mean procedure time of chest small incision group was significantly shorter than that of cardiac catheter group (76.25±20.24 VS 92.56±34.18 min, P<0.05). The mean occluder delivery times of chest small incision group was less than that of cardiac catheter group (1.0 VS 1.48±0.95 times , P<0.05). Two major complications occurred in cardiac catheter group , but no one occurred in chest small incision group . Forty-one patients were followed-up from 1 months to 30 months , all of patients were free from residual leak and occluder dislodgment.
Conclusion Both paths can achieve secure occlusion for isolated secundum ASD with mild trauma and fast postoperative recovery and good cosmetic result. Interventional device closure of ASD through cardiac catheter involves slightly low success rate and relatively narrow indication and difficult technique whereas through chest small incision offers relatively wider indication and simple technique and higher success rate or safety.
引文
1 King TD, Thompson SL, Steiner C, et al. Secundum atril septal defect nonoperative closure during cardiac catheterization . JAMA,1976, 235:2506-2509.
2 Masura J ,Gavara P ,Formanek A , et al. Transcatheter closure of secundum atrial septal defects using the new self - centering Amplatzer septal occluder :initial human experience. Cathet Cardiovasc Diagn ,1997 ,42 (2) :388-391.
3 易定华, 俞世强, 徐学增, 等. 经胸小切口封堵房间隔缺损手术效果观察. 中国微创外科杂志, 2006, 6(2): 113-114.
4 李红昕, 郭文彬, 郭兰敏, 等. 非体外循环房间隔缺损封堵术50例临床分析. 中华外科杂志, 2005, 43(10): 653-654.
5 黄陈军, 袁彪, 赵胜, 等. 经胸小切口大型房间隔缺损封堵术的临床应用. 江苏医药, 2006 ,32(8):708-709.
6 Luo WJ, Chang CF, Chen SX, et al. Ministernotomy versus full sternotomy in congenital heart defects: a prospective randomized study . Ann Thorac Surg, 2001,71(2):473–475.
7 刘迎龙,张宏家,孙寒松,等. 右胸外侧小切口小儿先天性心脏畸形矫治术793例体会. 中国循环杂志,2000,15(4):201-203.
8 Morgan JA, Peacock JC, Kohmoto T, et al. Robotic techniques improve quality of life in patients undergoing atrial septal defect repair[ J ]. Ann Thorac Surg, 2004, 77 (4) : 1328-1333.
9 Du ZD, Hijazi ZM, Kleinman CS, et al. Comparison between transcatheter and surgical closure of secundum atrial septal defect in children and adults: results of a multicenter nonrandomized trial. J Am Coll Cardiol ,2002, 39:1836–1844.
10 Kaulitz R, Paul T, Hausdorf G. Extending the limits of transcatheter closure ofatrial septal defects with the double umbrella device. Cardio SEAL [ J ]. Heart, 1998, 80 (1) :54-57.
11 Formigari R, Santoro G, RossettiL, et al. Comparison of three different atrial septal defect occlusion devices [ J ]. Am J Cardiol, 1998, 82 (5) : 690-692.
12 Formigari R, Santoro G, Rossetti L, et al. Comparison of three different atrial septal defect occlusion devices. Am J Cardiol, 1998, 82: 690 - 692.
13 Berger F, Ewert P, Bjornstad PG, et al. Transcatheter closure as standard treatment for moat interatrial defects: experience in 200 patients treated with the Amplatzer septal occluder. Cardiol Young, 1999, 9: 468 - 473.
14 Pedra CA, Pihkala J, Lee KJ, et al. Transcatheter closure of atrial septal defects using the cardio-seal implant. Heart, 2000, 84(3):320-326.
15 Chau AK,Leung MP,Yung T,et al. Surgical validation and implications for transcatheter closure of quantitative echocardiographic evaluation of atrial septal defect. Am J Cardiol,2000,85:1124-1130.
16 Thomson JD, Aburawi EH, Watterson KG, et al. Surgical and transcatheter (Amplatzer) closure of atrial septal defects:a prospective comparison of results and cost. Heart 2002, 87:466 –469.
17 Hughes ML, Maskell G, Goh TH, et al. Prospective comparison of costs and short term health outcomes of surgical versus device closure of atrial septal defect in children. Heart, 2002, 88:67–70.
18 Kim JJ, Hijazi ZM. Clinical outcomes and costs of Amplatzer transcatheter closure as compared with surgical closure of ostium secundum atrial septal defects. Med Sci Monit,2002,8: CR787–791.
20 Vida VL, Barnoya J, O'Connell M, et al. Surgical versus percutaneous occlusion of ostium secundum atrial septal defects. Results and cost-effectiveness in a low income country. J Am Coll Cardiol , 2006, 47: 326–331.
21 杨振文, 戴汝平, 张戈军. 继发孔型房间隔缺损介入治疗和外科手术的对比分析. 中华心血管病杂志, 2004,32(5):390-393.
22 蒋世良, 徐仲英, 黄连军. 采用Amplatzer 封堵器介入治疗继发孔房间隔缺损的并发症的防治. 中国介入心脏病学杂志, 2004, 12(6): 323-325.
23 Preventza O , Sampath-Kumar S , Wasnick J , et al. Late cardiac perforation following transcatheter atrial septal defect closure. Ann Thorac Surg , 2004 ,77 :1435-1437.
24 喻本桐, 刘季春, 万于华. 经胸小切口非体外循环房间隔缺损封堵术的临床应用. 中国心血管病研究杂志, 2006, 4(8): 626-627.
25 Holzer R, Hijazi ZM. Interventional approach to congenital heart disease . Curr Opin Cardiol, 2004, 19(2):84-90.
26 苏肇伉. 微创外科在小儿先天性心脏病治疗中的现状与展望 . 中国微创外科杂志,2004,4:360-362.
1. Komai H, Naito Y, Fujiwara K, et al. Cosmetic benefits of lower midline skin incision for pediatric open heart operation. a review of 100 cases. Jpn J Thorac Cardiovasc Surg, 2002, 50 (2) : 55~58.
2. Hopkins RA, Bert AA, Buchholz B, et al. Surgical patch closure of atrial septal defects.Ann Thorac Surg, 2004,77:2144 ~2150.
3. Nicholson IA , Bichell DP, Bacha EA , et al. Minimal sternotomy approach for congenital heart operations. Ann Thorac Surg,2001, 71 (2) : 469~472.
4. Yoshimura N , Yamaguchi M , Osh ima Y, et al. Repair of atrial septal defect through a right postero lateral thoracotomy: a cosmetic approach for female patients. Ann Thorac Surg. 2001,72 (6) : 2103~2105.
5. Laussen PC, Bichell DP,McGowan FX, et al. Postoperative recovery in children after minimum versus full-length sternotomy. Ann Thorac Surg, 2000,69:591–596.
6. Luo WJ, Chang CF,Chen SX, et al. Ministernotomy versus full sternotomy in congenital heart defects: a prospective randomized study .Ann Thorac Surg. 2001,71(2):473–475.
8 . 刘迎龙,张宏家,孙寒松,等. 右胸外侧小切口小儿先天性心脏畸形矫治术793 例体会. 中国循环杂志,2000,15(4):201-203.
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28. King TD, Thompson SL, Steiner C, et al. Secundum atril septal defect nonoperative closure during cardiac catheterization . JAMA,1976, 235:2506-2509.
29. Kaulitz R, Paul T, Hausdorf G, et al. Extending the limits of transcatheter closure of atrial septal defects with the double umbrella device. Cardio SEAL [J]. Heart, 1998, 80 (1) : 54.
30. Formigari R, Santoro G, RossettiL, et al. Comparison of three different atrial septal defect occlusion devices [J]. Am J Cardiol, 1998, 82 (5) : 690.
31. Masura J, Gavora P, Formanek A, et al. Transcatheter closure of secundum atrial septal defects using the new self-centering Amplatzer septal occluder: initial human experience[J]. Cathet Cardiovasc Diagn, 1997, 42 (4) : 388.
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33. Du ZD, Hijazi ZM, Kleinman CS, et al.Comparison between transcatheter and surgical closure of secundum atrial septal defect in children and adults: results of a multicenter nonrandomized trial. J Am Coll Cardiol ,2002, 39:1836–1844.
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43. 易定华, 俞世强, 徐学增. 经胸小切口封堵房间隔缺损手术效果观察. 中国微创外科杂志, 2006, 6(2): 113-114.
2 Masura J ,Gavara P ,Formanek A , et al. Transcatheter closure of secundum atrial septal defects using the new self - centering Amplatzer septal occluder :initial human experience. Cathet Cardiovasc Diagn ,1997 ,42 (2) :388-391.
3 易定华, 俞世强, 徐学增, 等. 经胸小切口封堵房间隔缺损手术效果观察. 中国微创外科杂志, 2006, 6(2): 113-114.
4 李红昕, 郭文彬, 郭兰敏, 等. 非体外循环房间隔缺损封堵术50例临床分析. 中华外科杂志, 2005, 43(10): 653-654.
5 黄陈军, 袁彪, 赵胜, 等. 经胸小切口大型房间隔缺损封堵术的临床应用. 江苏医药, 2006 ,32(8):708-709.
6 Luo WJ, Chang CF, Chen SX, et al. Ministernotomy versus full sternotomy in congenital heart defects: a prospective randomized study . Ann Thorac Surg, 2001,71(2):473–475.
7 刘迎龙,张宏家,孙寒松,等. 右胸外侧小切口小儿先天性心脏畸形矫治术793例体会. 中国循环杂志,2000,15(4):201-203.
8 Morgan JA, Peacock JC, Kohmoto T, et al. Robotic techniques improve quality of life in patients undergoing atrial septal defect repair[ J ]. Ann Thorac Surg, 2004, 77 (4) : 1328-1333.
9 Du ZD, Hijazi ZM, Kleinman CS, et al. Comparison between transcatheter and surgical closure of secundum atrial septal defect in children and adults: results of a multicenter nonrandomized trial. J Am Coll Cardiol ,2002, 39:1836–1844.
10 Kaulitz R, Paul T, Hausdorf G. Extending the limits of transcatheter closure ofatrial septal defects with the double umbrella device. Cardio SEAL [ J ]. Heart, 1998, 80 (1) :54-57.
11 Formigari R, Santoro G, RossettiL, et al. Comparison of three different atrial septal defect occlusion devices [ J ]. Am J Cardiol, 1998, 82 (5) : 690-692.
12 Formigari R, Santoro G, Rossetti L, et al. Comparison of three different atrial septal defect occlusion devices. Am J Cardiol, 1998, 82: 690 - 692.
13 Berger F, Ewert P, Bjornstad PG, et al. Transcatheter closure as standard treatment for moat interatrial defects: experience in 200 patients treated with the Amplatzer septal occluder. Cardiol Young, 1999, 9: 468 - 473.
14 Pedra CA, Pihkala J, Lee KJ, et al. Transcatheter closure of atrial septal defects using the cardio-seal implant. Heart, 2000, 84(3):320-326.
15 Chau AK,Leung MP,Yung T,et al. Surgical validation and implications for transcatheter closure of quantitative echocardiographic evaluation of atrial septal defect. Am J Cardiol,2000,85:1124-1130.
16 Thomson JD, Aburawi EH, Watterson KG, et al. Surgical and transcatheter (Amplatzer) closure of atrial septal defects:a prospective comparison of results and cost. Heart 2002, 87:466 –469.
17 Hughes ML, Maskell G, Goh TH, et al. Prospective comparison of costs and short term health outcomes of surgical versus device closure of atrial septal defect in children. Heart, 2002, 88:67–70.
18 Kim JJ, Hijazi ZM. Clinical outcomes and costs of Amplatzer transcatheter closure as compared with surgical closure of ostium secundum atrial septal defects. Med Sci Monit,2002,8: CR787–791.
20 Vida VL, Barnoya J, O'Connell M, et al. Surgical versus percutaneous occlusion of ostium secundum atrial septal defects. Results and cost-effectiveness in a low income country. J Am Coll Cardiol , 2006, 47: 326–331.
21 杨振文, 戴汝平, 张戈军. 继发孔型房间隔缺损介入治疗和外科手术的对比分析. 中华心血管病杂志, 2004,32(5):390-393.
22 蒋世良, 徐仲英, 黄连军. 采用Amplatzer 封堵器介入治疗继发孔房间隔缺损的并发症的防治. 中国介入心脏病学杂志, 2004, 12(6): 323-325.
23 Preventza O , Sampath-Kumar S , Wasnick J , et al. Late cardiac perforation following transcatheter atrial septal defect closure. Ann Thorac Surg , 2004 ,77 :1435-1437.
24 喻本桐, 刘季春, 万于华. 经胸小切口非体外循环房间隔缺损封堵术的临床应用. 中国心血管病研究杂志, 2006, 4(8): 626-627.
25 Holzer R, Hijazi ZM. Interventional approach to congenital heart disease . Curr Opin Cardiol, 2004, 19(2):84-90.
26 苏肇伉. 微创外科在小儿先天性心脏病治疗中的现状与展望 . 中国微创外科杂志,2004,4:360-362.
1. Komai H, Naito Y, Fujiwara K, et al. Cosmetic benefits of lower midline skin incision for pediatric open heart operation. a review of 100 cases. Jpn J Thorac Cardiovasc Surg, 2002, 50 (2) : 55~58.
2. Hopkins RA, Bert AA, Buchholz B, et al. Surgical patch closure of atrial septal defects.Ann Thorac Surg, 2004,77:2144 ~2150.
3. Nicholson IA , Bichell DP, Bacha EA , et al. Minimal sternotomy approach for congenital heart operations. Ann Thorac Surg,2001, 71 (2) : 469~472.
4. Yoshimura N , Yamaguchi M , Osh ima Y, et al. Repair of atrial septal defect through a right postero lateral thoracotomy: a cosmetic approach for female patients. Ann Thorac Surg. 2001,72 (6) : 2103~2105.
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