摘要
目的探讨电视胸腔镜(VATS)下钳闭与导管介入封堵治疗先天性心脏病动脉导管未闭(PDA)的手术方法,以减轻手术创伤,提高手术效果。方法 1995年11月至2009年9月福建省立医院心外科共收治动脉导管未闭患者312例,其中胸腔镜下钳闭(VATS组)252例,男78例,女174例;年龄7 d^31岁(9.16±8.91岁);均在全胸腔镜下钛夹钳闭未闭动脉导管。导管介入封堵(PCO组)治疗60例,男17例,女43例;年龄4~57岁(25.55±14.10岁);采用Amplatzer方法封堵。对两组患者的手术效果、并发症发生情况、住院费用等临床指标进行比较分析。结果 VATS组患者均成功钳闭动脉导管,无残余分流;PCO组3例(5%)患者有少量残余分流;两组患者均无死亡;手术时间及住院时间PCO组均短于VATS组(70.20±31.20 min vs.112.50±16.30 min,t=6.344,P=0.002;4.70±2.20 d vs.6.50±2.80 d,t=3.241,P=0.022),但平均住院费用PCO组显著高于VATS组(23 222.00±4 333.40元/例vs.8 904.50±2 634.60元/例,t=25.360,P=0.000)。结论与导管介入封堵手术比较,VATS下动脉导管钳闭术,特别适用于新生儿和婴幼儿,手术效果满意,费用仅为导管介入封堵手术的1/3。
Objective To investigate video-assisted thoracoscopic surgery（VATS） and percutaneous catheter occlusion（PCO） in interruption of patent ductus arteriosus（PDA）,in order to achieve minimally invasive surgical injuries and better clinical results. Methods From November 1995 to September 2009,312 cases of PDA were treated in Fujian provincial hospital, among whom 252 patients were interrupted with VATS（VATS group） and 60 patients with PCO technique（PCO group）.For the VATS group,there were 78 males and 174 females aged from 7 d to 31 years old（9.16±8.91 years）,while there were 17 males and 43 females aged from 4 to 57 years old（25.55±14.10 years） in the PCO group.We used titanium clip to interrupt PDA under video-assisted thoracoscope for patients in the VATS group,and adopted Amplatzer method for patients in the PCO group.The clinical results,complications and hospital cost in the two groups were compared in this study. Results In the VATS group,all the PDA were successfully interrupted with no residual shunt.In the PCO group,5%（3/60） of the patients had minor residual shunt after the procedure.No mortality occurred in both groups.Time of the procedure and hospital stay in the PCO group were shorter than that in the VATS group（70.20±31.20 min vs.112.50±16.30 min,t=6.344,P=0.002;and 4.70±2.20 d vs.6.50±2.80 d,t=3.241,P=0.022,respectively）.However,the hospital cost for each patient in the PCO group was much higher than that in the VATS group（23 222.00±4 333.40 yuan RMB vs.8 904.50±2 634.60 yuan RMB,t=25.360,P=0.000）. Conclusion Compared with PCO,VATS in interrupting PDA can achieved not only excellent clinical results,especially in the new-born and baby cases,but also very satisfying cost which is just a little more than one third of the PCO cost.
出处
《中国胸心血管外科临床杂志》
CAS
2010年第5期370-373,共4页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
关键词
动脉导管未闭
电视胸腔镜手术
导管介入封堵手术
Patent ductus arteriosus
Video-assisted thoracoscopic surgery
Percutaneous catheter occlusion
