摘要
目的探讨和评价右胸前外侧切口、胸骨下段小切口和胸骨正中切口治疗先天性室间隔缺损的优劣，以期进一步提高临床治疗效果。方法2015年3月至2016年12月间，我院共为198例患者行先天性室间隔缺损修补术，根据手术方式不同分为3组：胸骨下段小切口组（LMS Group，n=66）、右胸前外侧切口组（RLT Group，n=59）及胸骨正中切口组（SMS Group，n=73）。所有患者均常规建立体外循环。收集术前一般临床资料和术中体外循环时间、主动脉阻断时间及ICU停留时间。结果所有患者均顺利完成手术，无死亡及二次开胸止血。微创切口手术患者均顺利完成手术，术中无中转为正中开胸手术治疗。LMS组、RLT组及SMS组患者体外循环时间分别为（37．73±11．46）min、（41．3±13．97）min、（36．99±10．84）min，三组间比较未见统计学差异（P=0．078）；主动脉阻断时间分别为（23．85±9．78）min、（22．54±9．08）min、（19．23±6．92）min，三组间比较差异有统计学意义（P=0．009）。SMS组患者的切口最长，为（7．45±1．54）cm，LMS组患者为（5．58±0．8）cm，RLT组患者为（5．96±1．48）cm，三组间比较差异有统计学意义（P〈0．01）。结论右胸前外侧切口、胸骨下段小切口行先天性室间隔缺损修补术疗效确切，安全性好，更为美观，在一定条件下可替代胸骨正中切口方式。
Objective This retrospective study reviews our results and experience with lower mini-sternotomy （LMS） technique and right lateral thoraeotomy （RLT） technique for ventricular septal defect closure compared with SMS. Methods Between March 2015 and Dec 2016, 198 patients underwent repair VSD through lower mini-sternotomy （LMS Group, n=66）, fight lateral thoracotomy （RLT Group, n=59 ）, standard median sternotomy （SMS Group, n=73 ）. Cardiopulmonary bypass was achieved directly in the three different approaches. Results Procedures were performed successfully in all patients among the three groups and no in-hospital mortality occurred. No patient was reverted to standard median sternotomy in LMS Group and RLT Group. The CPB time was （37.73±11.46）min in LMS Group, （41.3±13.97）min in RLT Group and （36.99±10.84）min in SMS Group （P=0.078）; the cross-clamp time were （23.85±9.78）min in LMS Group, （22.54±9.08）min in RLT Group and （19.23±6.92）rain in SMS Group （/9=-0.009）. The total incision length of the procedure in SMS Group （7.45±1.54）cm was longer than the other groups [ LMS Group （ 5.58 ±0.80 ）cm and RLT Group （ 5.96 ± 1.48 ）cm ] and the difference was significant（P〈0.001 ）. Conclusion Both the LMS and RLT approach can perform with favorable cosmetic and acceptable clinical results for closing VSD. They are the promising alternatives to standard median sternotomy and merits further study.
作者
宋杰
王波
宋来春
金晶
许铭
华正东
张达雄
SONG Jie, WANG Bo, SONG Lai-chun, et al.(Department of Cardiac Surgery, Asia Heart Hospital, Wuhan 435002, Chin)
出处
《中国心血管病研究》
CAS
2018年第3期242-245,共4页
Chinese Journal of Cardiovascular Research
关键词
先天性心脏病
室间隔缺损
微创手术
Congenital heart disease
Ventricular septal defect
Minimally invasive surgery
