摘要
目的评价经胸骨旁小切口微创体外循环下房间隔缺损的治疗与经传统开胸手术治疗的优缺点。方法回顾性分析2010年11月至2014年3月华西医院心脏外科行体外循环单纯房间隔缺损修补术55例患者的临床资料,其中男16例、女39例,年龄25.8（9~56）岁。根据术前手术入路不同将患者分为胸部正中切口组（开胸组,15例）和胸骨旁小切口组（小切口组,40例）。术前两组患者年龄、性别、体重、心功能分级（NYHA）、房间隔缺损直径差异无统计学意义（P〉0.05）。评估两组患者术中、术后数据及随访半年后的疗效。结果全组无术后死亡病例。开胸组1例因术后心功能差延长了住院时间,小切口组1例因肺部感染延长住院时间。小切口组患者的手术时间、体外循环时间更长,且差异有统计学意义（P=0.007,P〈0.001）;住院费用更高,差异也有统计学意义（P=0.040）,术中平均出血量、术后第1 d胸腔总引流量均明显减少,差异有统计学意义（P均小于0.001）。两组主动脉阻断时间（P=0.500）和术后平均住院时间差异无统计学意义（P=0.290）。排除学习曲线的干扰,两组患者手术时间（P=0.275）和住院费用（P=0.188）差异无统计学意义,而体外循环时间差异仍有统计学意义（P=0.007）。随访6个月后两组患者均未出现残余分流,无伤口并发症。两组术后3周可从事非重体力活动的比例差异有统计学意义（P〈0.001）。结论胸骨旁小切口治疗房间隔缺损安全、有效、微创,开展较容易,学习曲线短,可作为房间隔缺损微创整体治疗流程中的重要一环。
Objective To evaluate the advantages and disadvantages of parasternal minimally incision surgery over median sternotomy to treat atrial septal defect（ASD） patients. Methods We retrospectively analyzed the clinical data of 55 ASD patients received ASD closure under cardiopulmonary bypass（CPB） in Department of Cardiovascular Surgery, West China Hospital from November 2010 through March 2014. There were 16 males and 39 females with an average age of 25.8（range, 9-56 years）. All the patients were divided into two groups depending on different surgical approach： a median sternotomy group（a MS group, 15 patients）and a parasternal minimally incision group（a PMI group, 40 patients）. There was no statistical difference in age, gender, weight, cardiac function classification（NYHA）, and atrial septal defect diameter between the two groups（P〉0.05）. We analyzed the clinical data of the patients and followed up for 6 months. Results After operation, no death occurred in the two groups. One patient in the MS group prolonged hospitalization due to poor postoperative heart function. One patient in the PMI group prolonged hospitalization because of pulmonary infection. Patients in the PMI group had longer operation time（P=0.007） and cardiopulmonary bypass（CPB） time（P〈0.001）, higher cost in hospital（P=0.040）, less intraoperative blood loss, less postoperative drainage volume on the first day（both P〈0.001）. There was no statistical difference in aortic clamp time（P=0.500） mean hospital stay（P=0.290） after operation between the two groups. To eliminate the interference of the learning curve, there was no statistical difference in operation time（P=0.275） and hospitalization cost（P=0.188） between the two groups. Whilethere was a statistical difference in CPB time between the two groups（P=0.007）. There was no remnant shunts or wound complications in the two groups at the end of following up for 6 months. More patients in the PMI group could engage in non-strenuo
出处
《中国胸心血管外科临床杂志》
CAS
CSCD
2016年第1期17-20,共4页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
基金
国家自然科学基金(39970734)~~
关键词
房间隔缺损
胸骨旁切口
微创治疗流程
Atrial septal defect
Parasternal minimally incision
Minimally invasive treatment procedure
