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经导管国产封堵器与外科手术治疗心室间隔缺损对比研究(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2005年第2期
页码:
175-177
栏目:
介入治疗
出版日期:
2005-03-05

文章信息/Info

Title:
Comparison of surgery versus domestic-made VSD occluder device implantation.in the closure of ventricular septal defects
作者:
代政学1;  关英敏进修生1;  崔旭辉1;  张玉顺1 ;  王海昌1;  贾国良1 ;  李寰;  刘建平1; 张军2; 李军2;  王小燕1
第四军医大学西京医院:1心血管内科 2超声科 陕西 西安 710032
Author(s):
DAI Zhengxue; GUAN Yingmin; CUI Xuhui; ZHANG Yushun; WANG Haichang;  JIA Guoliang; LI Huan;  LIU Jianping;  ZHANG Jun; LI Jun;  WANG Xiaoyan
Department of Cardiology, Xijing Hospital, Fourth Military Medical University, Xi′an，Shaanxi 710032,China
关键词:
封堵;  心脏直视手术;  房间隔缺损
Keywords:
domesticmade ASD occluder;  ventricular septal defect; surgery
分类号:
R541.4
DOI:
-
文献标识码:
A
摘要:
目的 比较经导管封堵与心脏直视手术治疗室间隔缺损(VSD)的疗效和并发症。方法 采用相同的入选标准，从2002年在我院接受治疗的VSD患者，选择符合条件的患者共458人。外科手术组患者215（男81，女134）例。介入治疗组243（男96，女147）例。外科手术组和介入治疗组年龄分别为9±10岁和8±11岁（P>0.05）；VSD大小分别为8.5±5.0 mm和8.4±6.1 mm(P>0.05)。结果 全组无死亡。介入治疗组和外科手术组的成功率分别为99.2％和100％（P>0.05）。介入治疗组术后即刻左心室造影示44例（18.1%）存在微~少量残余分流，199例（81.9%）封堵完全无残余分流。术后24~48 h超声心动图示分流完全消失223例（91.8%）、微~少量残余分流20例（8.2%）。1例封堵术后24 h 发生溶血，经过7 d内科保守治疗治愈。5例封堵术后3 d发生一过性Ⅲ度房室传导阻滞，经过4~10 d内科保守治疗治愈。1个月超声心动图发现2例残余分流（0.8%），均为少量。外科手术组1个月超声心动图发现2例残余分流（0.9%），5例封堵术后3 d发生一过性Ⅲ度房室传导阻滞，5例经过4~10 d内科保守治疗治愈,1例需安装心脏永久起搏器治疗。.介入治疗组中无一例患者需要输血，外科手术组中86例患者需要输血，平均输血量为547±171 ml。瓣膜关闭不全介入治疗组显著低于外科手术组.两组治疗费用分别为2956±542元和2536±742元（P<0.05)。介入治疗组和外科手术组的住院天数分别为6±2 d和14±6 d（P<0.01)。结论 和心脏直视手术治疗相比较, 经导管封堵ASD痛苦更小，恢复更快、并发症更少且无需体外循环及输血，值得推广应用，心脏直视手术应作为经导管封堵VSD的补充手段。
Abstract:
AIM To compare effectiveness, complications, and cost of domesticmade VSD occluder with surgical in ventricular septal defect (VSD) closure. METHODS We prospectively compared closure rates, complication rates, cost, inpatient stay, and home convalescent time in 458 patients with ventricular septal defects: 215 cases (9±10 years) were treated surgically and 243 cases(8±11 years) were treated by percutaneous domesticmade VSD septal occluder. RESULTS domesticmade VSD occluder closure was successful in 241 of 243 (99.1%) patients. Surgical closure was successful in all 215 cases. In domesticmade VSD septal occluder group, the left ventricular graphies(LVG) showed that 199（81.9%）patients had complete immediate closure, 44（18.1%）had a trace to small shunt immediately after the procedures;Within 24~48 h, color Doppler revealed complete closure in 223（91.8%） patients and a trace to small shunt in 20 patients （8.2%）; 5 cases suffered with temporary Ⅲ° atrial ventricular block and returned to normal 4~10 days after medicines treatment;One patient developed hemolysis 24h after the procedure and recovered 7 days after medicines treatment; Doppler revealed that a trace to small shunt in 2 patients 1mo after the procedure. In surgical group, doppler revealed that a trace to small shunt in 2 patients 1mo after the procedure; 5 cases suffered with temporary Ⅲ°atrial ventricular block and returned to normal 4~10 days after medicines treatment;One patient developed hemolysis 24h after the procedure and recovered 7 days after medicines treatment.Blood products were administered to 86 patients in the surgical group and no patient in the device group (P<0.01). Both hospital stay and home convalescent times were significantly shorter after domesticmade VSD occluder closure (median hospital stay: domesticmade VSD occluder 5 day, surgery 14 days; median convalescent time: domesticmade VSD occluder two weeks, surgery 6 weeks). Median cost was slightly higher in surgical groups (domesticmade VSD occluder RMB 2956±542, surgical RMB 2536±742, P<0.05). CONSLUSION Transcatheter closure of ventricular septal defects with the domesticmade VSD occluder device has the advantage of fewer complications, shorter hospitalization, and reduced need of blood products. Nonetheless, the surgeon's ability to close any ventricular septal defect regardless of its size or location remains an important advantage of surgery.

参考文献/References

［1］ Hijazi ZM, Hakim F, Haweleh AA, et al. Catheter closure of perimembranous ventricular septal defects using the new Amplatzer membranous VSD occluder: Initial clinical experience［J］. Catheter Cardiovasc Interv, 2002, 56(4):508-515.

［2］任森根．膜周部室间隔缺损的介入治疗［J］．海南医学，2002，13(12)：115-116.

［3］李军， 张军， 姚志勇,等. 经胸超声心动图对室间隔缺损封堵术的选择标准和方法学研究［J］.中国超声医学杂志, 2003,19(8):584-587.

［4］左健，蔡振杰，张卫达，等. 应用Amplatzer室间隔缺损封堵器经导管关闭膜周部室间隔缺损［J］. 第四军医大学学报，2002，23(20) ： 封3-01.

［5］李军， 张军， 姚志勇，等. 经胸超声心动图在室间隔缺损封堵术中的应用研究［J］. 中国超声医学杂志, 2003,19(10):740-743.

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［7］李军， 张军， 张玉顺，等. 经胸超声心动图在国产双盘伞封堵室间隔缺损的应用价值［J］. 中国超声医学杂志,2004,20(4):273-275.

［8］秦永文， 赵仙先， 郑兴，等. 自制封堵器闭合膜部室间隔缺损的疗效评价［J］. 介入放射学杂志, 2004，13(2)：104-107.

备注/Memo

备注/Memo:
收稿日期：2004-12-30.
更新日期/Last Update: 2010-01-05