| ObjectiveAtrial septal defect(ASD)is one of the most common congenital heart disease,and its incidence is about 6% ~ 10% of the total number of congenital heart disease.At present the mainstream effect a radical cure method are as follows: Surgical repair with cardiopulmonary bypass(CPB),medicine percutaneous interventional closure,and the minimally invasive thoracic closure and the neck right internal jugular vein minimally invasive closure.These treatments have different indications and advantages and disadvantages.This research is about the Comparative study on treatment of atrial septal defect by minimally invasive percutaneous trans-jugular vein、transthoracic device closure and surgical repair,and statistics to explore the clinical curative effect of three methods,safety,feasibility and the complications,which provide certain reference basis for optimizing the treatment of ASD.MethodsFrom October 2014 to November 2017,a total of 39 cases of ASD patients in our hospital underwent minimally invasive closure of the right jugular vein.From August 2013 to November 2017,a total of 100 cases of ASD patients with minimally invasive thoracic surgery were performed in our hospital.From March 2012 to November 2017,there were 57 patients treated with ASD repair under CPB.The patients were excluded from the patients with other severe cardiac malformations,valvular lesions and important organ diseases,and severe pulmonary hypertension,which resulted in the right left shunt..Statistics of three groups of patients with gender,age,weight,height and size of ASD,and the distance of precava,postcava、atrioventricular valve and pulmonary vein and coronary sinus,operation time,success rate,recent complications,mortality,the rate of blood transfusion,and postoperative hospitalization days and hospitalization expenses and other materials,Compare the data analysis in three groups and between groups one by one.Results1.There were no statistically significant differences between the three groups in terms of sex ratio,weight,height and age(P>0.05).In the composition of ASD species than the proportion of the inferior vena type and in cavity type and mixed type statistical differences in the three groups(P value is less than 0.05,0.01 and 0.01 respectively),group comparison between surgical treatment compared with the rest of the two groups are differences,the neck and the chest group no difference;The central type type,there is significant difference in three groups(P < 0.01),the comparison between groups,the neck and the chest group there were no statistically significant difference between the two groups,the surgical group and the rest of the differences between the two groups have statistical significance.There were statistically significant differences between the three groups(P < 0.01),and the differences between the groups were different.Among them,ASD was the largest in surgical treatment,and the second was the minimally invasive sealing group.The smallest was the minimally invasive closure group.There was no significant difference in EF between the three groups before and after treatment(P>0.05).The blood loss was 2(2,5)ml in the cervical group,of which 0(0%)patients needed transfusion therapy.The blood loss was 10(5,20)ml in the thoracic group,and 1(1%)of the patients needed transfusion therapy.The blood loss in the repair group was 100(80,155)ml,of which 24(42.1%)patients needed transfusion therapy.Three groups of comparison,the bleeding and transfusion percentage were statistically significant(P < 0.01),the contrast between the bleeding group,contrast were statistical significance between groups,blood transfusion percentage comparison between groups,compared with the neck and the chest group has no statistical significance,the surgical group compared with the rest of the two groups was statistically significant;Jugular group patients were not retained in the drainage tube,no statistics,drain via chest group indwelling drainage tube in 9 cases(9%),led traffic is 38(20,100 ml),repair group indwelling drainage tube in 57 cases(100%),led traffic for 100 ml(80,177ml);There were statistically significant differences between the three groups of drainage tube retention ratio(P < 0.01),and the comparison between the two groups was statistically significant.There were statistically significant differences between the thoracic group and the surgical group(P < 0.01),and the comparison between the thoracic group and the surgical group was statistically significant(P < 0.01).There was no statistical difference in the duration of ICU monitoring and the use time of the ventilator after the three groups.Jugular group of patients in the recovery room after extubation and not to enter the ICU there were 24 cases(61.5%),25 cases(64.1%),the group of patients with thoracic surgery in the recovery room tube drawing and not to enter the ICU there were 30 cases(30%),13 cases(13%),repair group of patients with postoperative extubation failed in the recovery room,into the ICU,recovery room decannulation rate contrast three groups was statistically significant(P < 0.01),compared between each group were statistically significant,ICU occupancy contrast three groups was statistically significant(P < 0.01),compared between each group have statistical significance.2.There was no statistical difference in the limitation of TR and the proportion of TR before and after the operation of the three groups;There was no statistically significant difference in the comparison of TR before and after operation.No statistical significance was found in the three groups after operation.Comparing MR situation before and after operation between the three groups can be found: more than mild MR contrast was statistically significant(P < 0.01),the chest group compared with the neck and the surgical group had statistical significance,compared with carotid group and surgery group has no statistical significance.There was statistical significance in the improvement of the ratio comparison(P < 0.01).The comparison between the surgical group and the cervical group and the thoracotomy group was statistically significant,and the comparison between the cervical group and the transthoracic group was not statistically significant.There was no statistically significant difference between the three groups.3.The three groups of hospitalization cost comparison,contrast three groups was statistically significant(P < 0.01),the minimally invasive thoracic seal group is significantly higher than the neck seal and surgical treatment of the neck seal hospitalization cost is higher than surgery group;No statistics were found in the three groups;The success rate,postoperative complications,residual shunt,postoperative new TR,postoperative new postoperative PH,postoperative PH,and postoperative AR rate were not statistically significant.Conclusion1.It is safe and reliable to treat ASD by minimally invasive percutaneous trans-jugular vein、transthoracic device closure and surgical repair.2.Minimally invasive percutaneous trans-jugular vein、transthoracic device closure has little injury and pain,rapid recovery,and can avoid CPB,low proportion of blood transfusion,the short-term curative effect is good,but its selective treatment,and long-term efficacy still need further follow-up.3.The surgical treatment of ASD has a wide range of indications and a high success rate,and it has the advantages of better efficacy and lower hospitalization cost for MR(Mitral Regurgitation).However,the operation time is long,the intraoperative hemorrhage amount is much,the patient’s blood transfusion proportion is much,and the operation needs to apply CPB,the wound is bigger.4.The treatment of ASD by minimally invasive percutaneous trans-jugular vein、transthoracic device closure should strictly control the indications and improve the technical proficiency,so as to further improve the success rate,reduce intraoperative and postoperative complications.5.Surgical repair of ASD is still the main treatment at present,but for patients with indications,it is possible to choose the minimally invasive percutaneous trans-jugular vein、transthoracic device closure as the preferred treatment.6.Patients who are able to cooperate with themselves choose to minimally invasive percutaneous trans-jugular vein device closure for daytime surgery to reduce hospitalization days and make efficient use of medical resources. |
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