右腋下小切口入路与传统胸骨正中切口入路手术治疗室间隔缺损的对比研究  

A comparative study of right subaxillary small incision approach and traditional median sternal incision approach for ventricular septal defect

作　　者：陈涌[1] 莫绪明[1] 陈润森 戚继荣[1] 彭卫[1] 武开宏[1] 孙剑[1] 郁迪[1] 张玉喜[1] 王智琪[1] 杨玉忠[1] 庄著伦[1] 笪敏[1] 扈元利 钱波[1] Chen Yong;Mo Xuming;Chen Runsen;Qi Jirong;Peng Wei;Wu Kaihong;Sun Jian;Yu Di;Zhang Yuxi;Wang Zhiqi;Yang Yuzhong;Zhuang Zhulun;Da Min;Hu Yuanli;Qian Bo(Department of Cardiothoracic Surgery,Affiliated Children's Hospital,Nanjing Medical University,Nanjing 210019,China)

机构地区：[1]南京医科大学附属儿童医院心胸外科,南京210019

出　　处：《临床小儿外科杂志》2023年第5期419-424,共6页Journal of Clinical Pediatric Surgery

基　　金：国家自然科学基金面上项目(81970265);江苏省科技计划(资金)重大科技示范项目(BE2023710006)

摘　　要：目的比较右腋下小切口入路与传统胸骨正中切口入路手术治疗室间隔缺损的临床疗效与安全性。方法回顾性分析2020年10月至2023年1月南京医科大学附属儿童医院心脏中心收治的937例室间隔缺损患儿临床资料。年龄大于6个月、体重小于35 kg者被纳入右腋下切口组(487例),其余患儿被纳入正中切口组(450例)。观察指标包括手术时间,体外循环时间,主动脉阻断时间,术中出血量,术后胸腔引流量、呼吸机辅助时间、住院时间,以及术后肺不张、膈膨升、乳糜胸、鸡胸的发生率。结果右腋下切口组和正中切口组的手术时间〔(151.1±9.1)min比(151.4±11.3)min〕、体外循环时间〔(55.4±2.0)min比(55.4±2.1)min〕、主动脉阻断时间〔(30.0±1.7)min比(30.2±1.7)min〕相比,差异均无统计学意义(P>0.05);术中出血量〔(90.5±6.6)mL比(106.8±15.6)mL〕、术后胸腔引流量〔(95.1±12.0)mL比(172.7±15.3)mL〕、术后呼吸机辅助时间〔(9.4±0.9)h比(11.6±1.4)h〕、术后监护时间〔(33.7±5.6)h比(42.4±9.6)h〕、术后住院时间〔(9.1±1.1)d比(11.1±1.2)d〕相比,右腋下切口组均优于正中切口组,差异均有统计学意义(P<0.05);术后肺不张(7/487比3/450)、膈膨升(4/487比0/450)、乳糜胸(0/487比3/450)的发生率比较,差异均无统计学意义(P>0.05);鸡胸发生率(0/487比8/450)比较,正中切口组高于右腋下切口组,差异有统计学意义(P<0.05)。术后随访3~18个月,两组均无一例其他严重并发症发生。结论与传统正中切口入路手术相比,右腋下切口入路手术治疗室间隔缺损具有术中出血少、康复快、住院时间短等优点,手术安全,效果可靠。Objective To compare the clinical efficacy,safety and effectiveness of small right axillary incision versus traditional median sternal incision for ventricular septal defect(VSD).Methods The relevant clinical data were retrospectively reviewed for 937 hospitalized VSD children from October 2020 to January 2023.They were divided into two groups of right axillary incision(n=487)and median incision(n=450)according to surgical approach.The major observation parameters included operative duration,extracorporeal circulation time,aortic block time,volume of intraoperative hemorrhage,volume of postoperative drainage,postoperative ventilator-assisted time,postoperative hospitalization time,incidence of postoperative pulmonary atelectasis,diaphragmatic elevation,celiac disease and chicken chest.Results In right subaxillary small incision and median incision groups,the differences were not statistically significant in operative duration[(151.1±9.1)vs.(151.4±11.3)min],extracorporeal circulation time[(55.4±2.0)vs.(55.4±2.1)min]or aortic block time[(30.0±1.7)vs.(30.2±1.7)min](P>0.05).And volume of intraoperative hemorrhage[(90.5±6.6)vs.(106.8±15.6)ml],volume of postoperative drainage[(95.1±12.0)vs.(172.7±15.3)ml],postoperative ventilator-assisted time[(9.4±0.9)vs.(11.6±1.4)h],postoperative monitoring time[(33.7±5.6)vs.(42.4±9.6)h]and postoperative hospital stay[(9.1±1.1)vs.(11.1±1.2)d]were superior in right subaxillary incision group to those in median incision group.There were statistically significant differences(P<0.05).As for the incidence of postoperative pulmonary atelectasis,diaphragmatic elevation and celiac disease,there was no statistically significant inter-group difference(P>0.05).The incidence of chicken chest was higher in median incision group than in right axillary incision group with a statistically significant difference(P<0.05).No other serious complications occurred during a follow-up period of(3-18)months.Conclusion As compared with traditional median incision,right axillary incision offers

关 键 词：心脏病 先天畸形 最小侵入性外科手术 外科手术 儿童 

分 类 号：R726.5[医药卫生—儿科]