体表超声心动图引导下经胸微创封堵术治疗房间隔缺损的临床效果分析(1)
[摘要]目的 探討体表超声心动图(TTE)引导下经胸微创封堵术与胸腔镜下修补术治疗房间隔缺损(ASD)的临床效果，分析手术优缺点，探讨最佳手术方式。方法 选择2011年 7月～2017年1月在我院采用微创手术治疗的ASD 患者90例，根据手术方式分为将其分为对照组和观察组，每组45例。观察组行体表超声心动图(TTE)引导下经胸微创封堵术，对照组行胸腔镜下修补术，比较两组治疗效果。结果 两组患者的手术成功率的比较，差异无统计学意义(P>0.05)。而观察组患者的手术时间、术后ICU入住时间、使用呼吸机时间、术后住院时间均显著短于对照组，差异有统计学意义(P<0.05)；观察组患者的手术切口显著小于对照组，差异有统计学意义(P<0.05)，观察组患者的住院总费用低于对照组，差异有统计学意义(P<0.05)，术中出血量、术后胸腔引流量、总输血量少于对照组，差异有统计学意义(P<0.05)。两组患者的术后并发症发生率的比较，差异无统计学意义(P>0.05)。结论 两种手术方式均是治疗ASD安全有效的方法，但体表超声心动图(TTE)引导下经胸微创ASD封堵术无需体外循环，对患者创伤小，操作简便，临床效果显著，可在基层单位加以推广应用。
[关键词]外科封堵术；胸腔镜；先天性房间隔缺损；超声心动图引导
[中图分类号] R540 [文献标识码] A [文章编号] 1674-4721(2018)2(a)-0047-04
[Abstract]Objective To investigate the difference of clinical effect of transthoracic minimally-invasive closure and thoracoscopic repair in the treatment of atrial septal defect (ASD) under the guidance of transthoracic echocardiography (TTE) so as to analyze the advantages and disadvantages of two surgeries and discuss the best choice.Methods Ninety patients with ASD who underwent minimally invasive surgery in our hospital from July 2011 to January 2017 were selected and divided into control group and observation group according to the operation mode，with 45 cases in each group.The observation group was treated with transthoracic minimally invasive occlusion guided by body surface TTE，and the control group was treated with video-assisted thoracoscopic repair.The therapeutic effects of the two groups were compared.Altogether There was no significant difference between the two groups (P>0.05).The operation time，ICU stay time，ventilator use time and hospital stay were significantly shorter in the observation group than those in the control group (P<0.05).The size of surgical incision in the observation group was significantly smaller than that in the control group (P<0.05).The total cost of hospitalization in the observation group was lower than that in the control group (P<0.05).The amount of intraoperative bleeding， postoperative thoracic drainage and total blood transfusion in the observation group were lower than that in the control group (P<0.05).There was no significant difference in the incidence of postoperative complications between the two groups (P>0.05).Results There was no significant difference between the two groups (P>0.05).The operation time，ICU stay time，ventilator use time and hospital stay were significantly shorter in the observation group than those in the control group (P<0.05).The size of surgical incision in the observation group was significantly smaller than that in the control group (P<0.05).The total cost of hospitalization in the observation group was lower than that in the control group (P<0.05).The amount of intraoperative bleeding， postoperative thoracic drainage and total blood transfusion in the observation group were lower than that in the control group (P<0.05).There was no significant difference in the incidence of postoperative complications between the two groups (P>0.05).Conclusion Both the two surgeries are safe and effective methods for the treatment of ASD.But the TTE-guided minimally-invasive ASD closure has the features of less trauma， simple operation and significant clinical effect without extracorporeal circulation，which can be applied in the grass-roots units., 百拇医药(曹西迎 李章红 李树林 罗志方 熊健宪)
[关键词]外科封堵术；胸腔镜；先天性房间隔缺损；超声心动图引导
[中图分类号] R540 [文献标识码] A [文章编号] 1674-4721(2018)2(a)-0047-04
[Abstract]Objective To investigate the difference of clinical effect of transthoracic minimally-invasive closure and thoracoscopic repair in the treatment of atrial septal defect (ASD) under the guidance of transthoracic echocardiography (TTE) so as to analyze the advantages and disadvantages of two surgeries and discuss the best choice.Methods Ninety patients with ASD who underwent minimally invasive surgery in our hospital from July 2011 to January 2017 were selected and divided into control group and observation group according to the operation mode，with 45 cases in each group.The observation group was treated with transthoracic minimally invasive occlusion guided by body surface TTE，and the control group was treated with video-assisted thoracoscopic repair.The therapeutic effects of the two groups were compared.Altogether There was no significant difference between the two groups (P>0.05).The operation time，ICU stay time，ventilator use time and hospital stay were significantly shorter in the observation group than those in the control group (P<0.05).The size of surgical incision in the observation group was significantly smaller than that in the control group (P<0.05).The total cost of hospitalization in the observation group was lower than that in the control group (P<0.05).The amount of intraoperative bleeding， postoperative thoracic drainage and total blood transfusion in the observation group were lower than that in the control group (P<0.05).There was no significant difference in the incidence of postoperative complications between the two groups (P>0.05).Results There was no significant difference between the two groups (P>0.05).The operation time，ICU stay time，ventilator use time and hospital stay were significantly shorter in the observation group than those in the control group (P<0.05).The size of surgical incision in the observation group was significantly smaller than that in the control group (P<0.05).The total cost of hospitalization in the observation group was lower than that in the control group (P<0.05).The amount of intraoperative bleeding， postoperative thoracic drainage and total blood transfusion in the observation group were lower than that in the control group (P<0.05).There was no significant difference in the incidence of postoperative complications between the two groups (P>0.05).Conclusion Both the two surgeries are safe and effective methods for the treatment of ASD.But the TTE-guided minimally-invasive ASD closure has the features of less trauma， simple operation and significant clinical effect without extracorporeal circulation，which can be applied in the grass-roots units., 百拇医药(曹西迎 李章红 李树林 罗志方 熊健宪)