经静脉与经胸导管封堵术治疗室间隔缺损的配比研究

发布时间：2018-10-18 11:39

【摘要】：目的:经倾向得分匹配法(PSM)均衡组间基线后,对比经静脉导管封堵术(TVDC)与经胸导管封堵术(TTDC)治疗室间隔缺损(VSD)的成功率、并发症及住院费用等情况,为临床个体化选择提供依据。方法:选择2012年1月至2014年9月入住我院的VSD行TVDC者81例、行TTDC者263例。以81例行TVDC者为基础(TVDC组),根据年龄、体重和VSD直径进行倾向得分匹配。按1:2配比,得到符合配比条件、同期行TTDC患者162例(TTDC组)。通过收集其基线特征、手术情况、术前及术后检查及随访情况等资料,比较两种术式成功率、并发症(严重及一般并发症)、费用及住院天数等情况。结果:经1:2配比后两组基线资料无明显差异。配比后两组间封堵器直径(6.2±1.93 mm vs 6.64±1.96 mm,p=0.139)、手术成功率(95.1%vs 97.5%,p=0.525)及严重并发症发生率(0.0%vs 2.5%,p=0.304)均无明显差别,两组均无死亡病例。TTDC组一般并发症的发生率较TVDC组高(61.7%vs 46.9%,p=0.028)。在随访过程中,两组无严重并发症生存率无明显差异(Log-Rank检验:p=0.127),TVDC组无一般并发症生存率高于TTDC组(Log-Rank检验:p=0.004)。此外,TVDC组在住院时间(7.53±1.51天vs 11.09±4.03天,p0.001)、住院总费用(30123.71±6021.39元vs 37269.77±7749.02元,p=0.011)及全麻率(64.2%vs 100%,p0.001)方面均优于TTDC组。结论:TVDC和TTDC均可成功封堵VSD,前者在手术创伤、住院总费用、康复及美观等方面均优于后者。同时符合两种术式适应证的VSD患者,更建议行TVDC。
[Abstract]:Objective: to compare the success rate, complication and hospitalization cost of transvenous catheter closure (TVDC) and transthoracic catheter occlusion (TTDC) in the treatment of ventricular septal defect (VSD) after the baseline between the (PSM) equalization group with propensity score matching. To provide the basis for clinical individualized selection. Methods: 81 cases of VSD and 263 cases of TTDC were selected from January 2012 to September 2014. Based on 81 patients with TVDC (TVDC group), tendency scores were matched according to age, body weight and VSD diameter. According to the 1:2 ratio, the matching conditions were obtained. 162 cases of TTDC were given at the same time (TTDC group). By collecting the baseline features, surgical conditions, preoperative and postoperative examinations and follow-up data, the success rate, complications (severe and general complications), cost and length of stay of the two operations were compared. Results: there was no significant difference in baseline data between the two groups after 1:2 matching. There was no significant difference in occluder diameter (6.2 卤1.93 mm vs 6.64 卤1.96 mm,p=0.139), successful rate of operation (95.1%vs 97.5) and serious complication rate (0.0%vs 2.5 and p0.304) between the two groups after matching. The incidence of general complications in TTDC group was higher than that in TVDC group (61.7%vs 46.9 p0.028). During the follow-up, there was no significant difference between the two groups in the survival rate without serious complications (Log-Rank test: the survival rate of no complication in the group of 0.127), TVDC was higher than that in the group of TTDC (Log-Rank test: p0. 004). In addition, TVDC group was superior to TTDC group in terms of hospitalization time (7.53 卤1.51 days, vs 11.09 卤4.03 days, p0.001), total hospitalization cost (30123.71 卤6021.39 vs 37269.77 卤7749.02 yuan, p0.011) and general anesthesia rate (64.2%vs 100g / p0.001). Conclusion: both TVDC and TTDC are superior to VSD, in surgical trauma, total hospitalization cost, rehabilitation and beauty. It is recommended that TVDC. should be performed in patients with VSD who meet the indication of two kinds of operation at the same time.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R541.1

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