电视胸腔镜与正中胸骨切开心脏手术的比较  

Video-assisted thoracic surgery versus median sternotomy in cardiac septal defect treatment

作　　者：王显悦[1] 俞世强[1] 易定华[1] 徐学增[1] 程云阁[1] 

机构地区：[1]第四军医大学西京医院心血管外科,陕西西安710032

出　　处：《心脏杂志》2007年第6期720-722,共3页Chinese Heart Journal

基　　金：国家科技攻关项目资金资助(No.2004BA720A12)

摘　　要：目的通过比较电视辅助胸腔镜与正中胸骨切开心脏间隔缺损手术在疼痛、呼吸功能、血液系统改变及术后恢复等方面的差异,来明确电视辅助胸腔镜手术(VATS)的安全性及其优缺点。方法抽取行VATS和MS的患者各120例,为VATS组和正中胸骨切开术(MS)组。比较两组间术后疼痛,术后恢复的迅速程度,血液细胞记数改变,失血量以及输血量和呼吸功能等。结果二组间在主动脉阻闭时间和住院时间上无明显差异。在5岁以上VATS组患者101人中,用吗啡类止痛药物的16人,而MS组84人中有24人使用吗啡类止痛药物(P<0.05)。两组间动脉分析氧分压,养合指数以及呼吸机辅助时间无显著差异。VATS组手术时间长于MS组,而其ICU滞留时间短(P<0.01)。VATS组患者手术后失血及输血量少于对照组。结论VATS同MS同样安全可靠,虽然其手术时间长,但与MS组相比较,其术后恢复较快,术后疼痛轻,并且其失血及输血量少。AIM To examine the differences between video-assisted thoracic surgery （VATS）and median sternotomy （MS） in postoperative pain, rapidity of recovery, changes of complete blood count, blood loss, blood transfusion and respiratory function. METHODS One hundred and twenty patients were randomly sampled from VATS cases, while another 120 patients from MS for cardiac septal defect since September 2000. The clinical records from the two groups were compared in postoperative pain, operating time, aortic clamp time, RESULTS The aortic rapidity of recovery, changes of blood cells, blood loss and respiratory function. clamp time and length of stay in VATS group were not significantly different compared with that in MS group. Postoperative pain medication （Morphine and related drugs） was adminis tered to 16 of the 101 VATS patients, as compared with 24 of the 84 MS patients （ P 〈 0.05 ）. Data of postoperative respiratory function between the two groups had no statistically significant difference. Operating times were longer in the VATS than in the MSgroup, intensive care unit than MS patients （ P 〈 0.01 ）. There VATS patients. CONCLUSION VATS, just like MS, is while VATS patients had shorter stays in the were fewer blood transfusion and blood loss a safe and reliable method in treating cardiac septal defect disease. Although long operation time remains a problem in VATS procedures, our results suggest that VATS, compared with MS, has the advantage of earlier recovery and less pain. VATS with fewer blood loss and blood transfusion reduces the cost of hospitalization.

关 键 词：电视辅助胸腔镜手术 正中胸骨切开术 术后疼痛 呼吸功能 

分 类 号：R654.2[医药卫生—外科学]