【作者】 胡友洋；

【导师】 严中亚；

【作者基本信息】 安徽医科大学 ， 外科学， 2007， 硕士

【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。更多还原

【Abstract】 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.更多还原