单操作孔胸腔镜心脏不停跳房间隔缺损修补手术临床疗效分析  

Analysis of the clinical efficacy of single-operation thoracoscope bypass surgery with beating heart in the treatment of atrial septal defect repair

作　　者：王鹏[1] 刘学刚[1] 刁文杰 刘戈[1] 李海慧 施超[1] 刘以尧[1] 孟金金[1] 石宇[1] WANG Peng;LIU Xue-gang;DIAO Wen-jie;LIU Ge;LI Hai-hui;SHI Chao;LIU Yi-yao;MENG Jin-jin;SHI Yu(Department of Cardiac Surgery,the First Affiliated Hospital of Bengbu Medical College,Bengbu,Anhui 233004,China)

机构地区：[1]蚌埠医学院第一附属医院心脏外科,安徽蚌埠233004

出　　处：《中华全科医学》2020年第2期194-196,212,共4页Chinese Journal of General Practice

基　　金：安徽省科技攻关项目(1804h08020280)。

摘　　要：目的探讨比较单操作孔胸腔镜心脏不停跳下手术与常规开胸手术行房间隔缺损修补的临床疗效。方法选取蚌埠医学院第一附属医院心脏外科中心于2015年9月-2018年12月被诊断为房间隔缺损的先天性心脏畸形患者52例,按照手术方式不同分为2组:观察组(单操作孔胸腔镜组)25例,采用单操作孔胸腔镜房间隔缺损修补手术;对照组(常规胸正中手术)27例,采用传统胸正中切口房间隔缺损修补手术。统计分析患者的一般情况、体外循环时间、手术总时间等围手术期指标以及术后并发症和术后随访情况。结果 2组患者手术均顺利完成,2组手术时间、体外循环时间、上下腔阻断时间、术后并发症比较差异均无统计学意义(均P>0.05),而术后呼吸机辅助时间[(10.80±4.70)h vs.(14.28±6.13)h,t=2.282,P=0.027]、监护室时间[(28.19±9.15)h vs.(46.54±21.51)h,t=4.053,P<0.001]、术中输血量[(216.00±172.43)mL vs.(366.67±227.02)mL,t=2.679,P=0.010]、术后24 h引流量[(146.32±157.78)mL vs.(315.37±251.87)mL,t=2.893,P=0.006],住院天数[(14.84±3.33)d vs.(19.48±7.46)d,t=2.933,P=0.006],差异均有统计学意义。2组患者术后随访2~36个月,无残余分流及其他异常,随访结果均满意。结论单操作孔胸腔镜下房间隔修补手术治疗房间隔缺损安全、有效、可行,创伤小,术后恢复快,切口更美观,值得推广应用。Objective To evaluate the clinical efficacy of single-operated thoracoscopic cardiopulmonary bypass surgery with beating heart and conventional thoracotomy for atrial septal defect repair. Methods A total of 52 patients with congenital cardiac malformations diagnosed with atrial septal defect from September 2015 to December 2018 in the Cardiac Surgery Center of the First Affiliated Hospital of Bengbu Medical College were divided into observation group(single operation thoracoscopy group, 25 cases) and control group(conventional thoracotomy, 27 cases) according to different surgical methods. The general conditions of patients, extracorporeal circulation time, total operation time and other perioperative indicators, postoperative complications, and postoperative follow-up were analyzed. Results The operations of the two groups were successfully completed. There was no significant difference in the operation time, CPB time, upper and lower cavity block time, and postoperative complications between the two groups(all P>0.05). There were significant difference in postoperative ventilator assist time [(10.80±4.70) h vs.(14.28±6.13) h, t=2.282, P=0.027], ICU time [(28.19±9.15) h vs.(46.54±21.51) h, t=4.053, P<0.001], intraoperative blood transfusion volume [(216.00±172.43) mL vs.(366.67±227.02) mL, t=2.679, P=0.010], 24 hours postoperative drainage [(146.32±157.78) mL vs.(315.37±251.87) mL, t=2.893, P=0.006], and length of hospital stay [(14.84±3.33) d vs.(19.48±7.46) d, t=2.933, P=0.006]. The patients in the two groups were followed up for 2 to 36 months after operation without residual shunts and other abnormalities, and the results were satisfactory. Conclusion The single-hole thoracoscopic atrial septal repair with beating heart is safe, effective and feasible for the treatment of atrial septal defect. The trauma is small, the postoperative recovery is quick, and the incision is more beautiful. It is worthy of popularization and application.

关 键 词：单操作孔胸腔镜 心脏不停跳 心内直视手术 房间隔缺损 

分 类 号：R654.2[医药卫生—外科学] R616.5[医药卫生—临床医学]