主动脉窦瘤破裂经导管封堵与外科手术治疗对比研究
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摘要
目的比较经导管封堵术及外科手术治疗主动脉窦瘤破裂的安全性和临床效果。方法回顾性分析2003年10月至2017年5月单中心连续31例主动脉窦瘤患者。11例接受经导管封堵术治疗,平均年龄(36.64±10.87)岁;20例接受外科手术治疗,平均年龄(28.90±10.06)岁。比较两组技术成功率、并发症、残余分流、手术时间、住院时间、输血量及住院费用等指标。结果两组患者年龄、性别及术前美国纽约心脏病协会(NYHA)心功能分级差异无统计学意义(P>0.05)。技术成功率在导管封堵组为100%(11/11),外科手术组为95%(19/20)(P>0.05)。导管封堵组、外科手术组输血量分别为0 ml、(427.25±331.36)ml(P<0.01),手术时间分别为(60.00±00.00)min、(205.50±129.35)min(P<0.05),入住重症监护病房(ICU)时间分别为0 d、(1.50±0.61)d(P<0.01),残余分流率分别为9.09%(1/11)、10.00%(2/20)。两组患者围术期均无死亡,住院时间和住院费用差异均无统计学意义(P>0.05)。结论两术式治疗主动脉窦瘤破裂均安全有效,但经导管封堵术在微创、手术时间及住院时间方面更具优势。对破口合适患者,可优选经导管封堵术。
Objective To compare the safety and clinical efficacy of transcatheter closure for ruptured aortic sinus aneurysm(RASA) with those of surgical treatment. Methods A total of 31 successive patients with RASA, who were treated in a single center during the period from October 2003 to May 2017,were enrolled in this study. Among them, 11 patients received transcatheter closure therapy, their mean age was(36.64±10.87) years old; 20 patients received surgical closure, their mean age was(28.90±10.06) years old. The technical success rate, complications, residual shunt, operation time, hospitalization days, amount of blood transfusion, medical expenses, etc. were compared between the two groups. Results No statistically significant differences in age, sex and preoperative cardiac functional grading established by the Heart Disease Association of New York(NYHA) existed between the two groups(P>0.05). The technical success rates in transcatheter closure group and surgical closure group were 100%(11/11) and 95%(19/20)respectively(P >0.05). The amounts of blood transfusion in transcatheter closure group and surgical closure group were 0 ml and(427.25±331.36) ml respectively(P<0.01). The time spent for operation in transcatheter closure group and surgical closure group was(60.00±00.00) min and(205.50±129.35) min respectively(P<0.05). Days staying in intensive care unit(ICU) in transcatheter closure group and surgical closure group were 0 day and(1.50±0.61) days respectively(P<0.01). The residual shunt rates in transcatheter closure group and surgical closure group were 9.09%(1/11) and 10.00%(2/20) respectively. None perioperative death occurred in both groups. No statistically significant differences in hospitalization days and in medical expenses existed between the two groups(P >0.05). Conclusion Both transcatheter closure and surgical closure are safe and effective for the treatment of ruptured RASA, although transcatheter closure therapy has more advantageous in aspect of minimally-invasive management, operative time and length of hospital stay. For patients with a RASA which position is suitable for percutaneous interventional management, transcatheter closure therapy should be employed as a preferred therapy.
Objective To compare the safety and clinical efficacy of transcatheter closure for ruptured aortic sinus aneurysm(RASA) with those of surgical treatment. Methods A total of 31 successive patients with RASA, who were treated in a single center during the period from October 2003 to May 2017,were enrolled in this study. Among them, 11 patients received transcatheter closure therapy, their mean age was(36.64±10.87) years old; 20 patients received surgical closure, their mean age was(28.90±10.06) years old. The technical success rate, complications, residual shunt, operation time, hospitalization days, amount of blood transfusion, medical expenses, etc. were compared between the two groups. Results No statistically significant differences in age, sex and preoperative cardiac functional grading established by the Heart Disease Association of New York(NYHA) existed between the two groups(P>0.05). The technical success rates in transcatheter closure group and surgical closure group were 100%(11/11) and 95%(19/20)respectively(P >0.05). The amounts of blood transfusion in transcatheter closure group and surgical closure group were 0 ml and(427.25±331.36) ml respectively(P<0.01). The time spent for operation in transcatheter closure group and surgical closure group was(60.00±00.00) min and(205.50±129.35) min respectively(P<0.05). Days staying in intensive care unit(ICU) in transcatheter closure group and surgical closure group were 0 day and(1.50±0.61) days respectively(P<0.01). The residual shunt rates in transcatheter closure group and surgical closure group were 9.09%(1/11) and 10.00%(2/20) respectively. None perioperative death occurred in both groups. No statistically significant differences in hospitalization days and in medical expenses existed between the two groups(P >0.05). Conclusion Both transcatheter closure and surgical closure are safe and effective for the treatment of ruptured RASA, although transcatheter closure therapy has more advantageous in aspect of minimally-invasive management, operative time and length of hospital stay. For patients with a RASA which position is suitable for percutaneous interventional management, transcatheter closure therapy should be employed as a preferred therapy.
引文
[1]Chu SH,Hung CR,How SS,et al.Ruptured aneurysms of the sinus of Valsalva in Oriental patients[J].J Thorac Cardiovasc Surg,1990,99:288-298.
[2]Dong C,Wu QY,Tang Y.Ruptured sinus of valsalva aneurysm:a Beijing experience[J].Ann Thorac Surg,2002,74:1621-1624.
[3]朱国勇,陈胜喜,罗万俊,等.主动脉窦瘤破裂的外科治疗[J].中国胸心血管外科临床杂志,2007,14:141-143.
[4]朱静怡,迟迪,刘向兰,等.主动脉窦瘤破裂的介入治疗进展[J].心血管病学进展,2015,36:538-541.
[5]李刚,姬尚义,沈宗林,等.主动脉窦瘤破裂的外科治疗[J].中国循环杂志,2004,10:8-10.
[6]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,1997,42:388-393.
[7]Chessa M,Carminati M,Butera G,et al.Early and late complications associated with transcatheter occlusion of secondum atrial septal defect[J].J Am Coll Cardiol,2009,39:1061-1065.
[8]Liu S,Xu X,Ding X,et al.Comparison of immediate results and mid-term follow-up of surgical and percutaneous closure of ruptured sinus of Valsalva aneurysm[J].J Cardiol,2014,63:239-243.
[9]蒋志华,陈广明,陈亮.主动脉窦瘤60例外科治疗分析[J].南京医科大学学报·自然科学版,2002,22:331-332.
[10]刘加立,钱文浩,王诚,等.经导管封堵主动脉窦瘤破裂[J].中国介入影像与治疗学,2012,9:516-519.
[11]Wang KY,St John Sutton M,Ho HY,et al.Congenital sinus of Valsalva aneurysm:a multiplane transesophageal echocardiographic experience[J].J Am Soc Echocardiogr,1997,10:956-963.
[12]Liu YL,Liu AJ,Ling F,et al.Risk factors for preoperative and postoperative progression of aortic regurgitation in congenital ruptured sinus of Valsalva aneurysm[J].Ann Thorac Surg,2011,91:542-548.
[13]伍广伟,许能文,王孟杰,等.经导管封堵方法治疗主动脉窦瘤破裂的疗效及随访评估[J].介入放射学杂志,2014,23:203-205.
[14]张敏郁,高宇,王建华,等.经胸超声心动图在主动脉窦瘤及其合并症诊断中的应用价值[J].中国循证心血管医学杂志,2015,7:60-63.
[15]徐刚,刘宏威,王延华,等.不典型主动脉窦瘤破裂误诊分析[J].内科急危重症杂志,1997,3:137-139.
[16]成革胜,张玉顺,何璐,等.两种封堵器治疗主动脉窦瘤破裂的疗效及安全性[J].中国介入影像与治疗学,2014,11:77-81.
[2]Dong C,Wu QY,Tang Y.Ruptured sinus of valsalva aneurysm:a Beijing experience[J].Ann Thorac Surg,2002,74:1621-1624.
[3]朱国勇,陈胜喜,罗万俊,等.主动脉窦瘤破裂的外科治疗[J].中国胸心血管外科临床杂志,2007,14:141-143.
[4]朱静怡,迟迪,刘向兰,等.主动脉窦瘤破裂的介入治疗进展[J].心血管病学进展,2015,36:538-541.
[5]李刚,姬尚义,沈宗林,等.主动脉窦瘤破裂的外科治疗[J].中国循环杂志,2004,10:8-10.
[6]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,1997,42:388-393.
[7]Chessa M,Carminati M,Butera G,et al.Early and late complications associated with transcatheter occlusion of secondum atrial septal defect[J].J Am Coll Cardiol,2009,39:1061-1065.
[8]Liu S,Xu X,Ding X,et al.Comparison of immediate results and mid-term follow-up of surgical and percutaneous closure of ruptured sinus of Valsalva aneurysm[J].J Cardiol,2014,63:239-243.
[9]蒋志华,陈广明,陈亮.主动脉窦瘤60例外科治疗分析[J].南京医科大学学报·自然科学版,2002,22:331-332.
[10]刘加立,钱文浩,王诚,等.经导管封堵主动脉窦瘤破裂[J].中国介入影像与治疗学,2012,9:516-519.
[11]Wang KY,St John Sutton M,Ho HY,et al.Congenital sinus of Valsalva aneurysm:a multiplane transesophageal echocardiographic experience[J].J Am Soc Echocardiogr,1997,10:956-963.
[12]Liu YL,Liu AJ,Ling F,et al.Risk factors for preoperative and postoperative progression of aortic regurgitation in congenital ruptured sinus of Valsalva aneurysm[J].Ann Thorac Surg,2011,91:542-548.
[13]伍广伟,许能文,王孟杰,等.经导管封堵方法治疗主动脉窦瘤破裂的疗效及随访评估[J].介入放射学杂志,2014,23:203-205.
[14]张敏郁,高宇,王建华,等.经胸超声心动图在主动脉窦瘤及其合并症诊断中的应用价值[J].中国循证心血管医学杂志,2015,7:60-63.
[15]徐刚,刘宏威,王延华,等.不典型主动脉窦瘤破裂误诊分析[J].内科急危重症杂志,1997,3:137-139.
[16]成革胜,张玉顺,何璐,等.两种封堵器治疗主动脉窦瘤破裂的疗效及安全性[J].中国介入影像与治疗学,2014,11:77-81.