胸骨下段小切口联合体外循环在小儿先天性房室间隔缺损手术中的应用分析  

Application of small sternal incision combined with cardiopulmonary bypass in children with congenital atrioventricular septal defect

作　　者：周洋[1] 唐仕海 赵飞[1] 郑波 彭华利[1] Zhou Yang;Tang Shihai;Zhao Fei;Zheng Bo;Peng Huali(Department of Cardiothoracic Surgery,People’s Hospital of Leshan,Sichuan Leshan 614000,China)

机构地区：[1]四川省乐山市人民医院胸心外科,四川乐山614000

出　　处：《中国医刊》2020年第5期518-521,共4页Chinese Journal of Medicine

基　　金：四川省医学科研青年创新课题(Q17041)。

摘　　要：目的探讨胸骨下段小切口联合体外循环在小儿先天性房室间隔缺损手术中的应用效果。方法回顾性分析2017年6月至2018年6月在四川省乐山市人民医院接受房室间隔缺损修补术的94例患儿的临床资料,根据手术切口的不同分为观察组(48例)和对照组(46例)。观察组在胸骨下段小切口联合体外循环下进行手术,对照组在胸骨正中切口联合体外循环下进行手术。比较两组患儿的手术时间、手术切口长度、升主动脉夹闭时间、体外循环时间、术后首日引流量、呼吸恢复时间、ICU住院时间、总住院时间以及术后近期和远期并发症发生情况。结果观察组患儿的手术时间、手术切口长度、呼吸恢复时间明显短于对照组,首日引流量明显少于对照组,差异有显著性(P<0.05);两组患儿升主动脉夹闭时间、体外循环时间、ICU住院时间、总住院时间比较差异无显著性(P>0.05)。观察组和对照组患儿术后并发症(胸腔积液、肺不张、肺炎、肺脓肿、心律失常等)发生率分别为14.58%、19.57%,组间比较差异无显著性(χ2=2.621,P=0.116)。观察组未发生胸骨畸形,对照组术后6例(13.0%)发生胸骨畸形,两组比较差异有显著性(χ2=10.637,P<0.001)。结论相较于传统胸骨正中切口,先天性房室间隔缺损患儿采用胸骨下段小切口联合体外循环手术创伤较小且不易发生胸骨畸形,保证了胸骨的美观与完整性,有助于提高临床治疗效果。Objective To analyze the effect of the combination of small incision in the lower sternum and cardiopulmonary bypass in the operation of children with congenital atrioventricular septal defect.Method The clinical data of 94 patients with ASD who were treated in our hospital from June 2017 to June 2018 were analyzed retrospectively.According to the different incisions,the patients were divided into two groups:the study group(48 cases)was treated with small incision under the sternum combined with cardiopulmonary bypass,and the control group(46 cases)was treated with median sternum combined with cardiopulmonary bypass.The operation time,incision length,clamping time of ascending aorta,cardiopulmonary bypass time,postoperative first day flow,respiratory recovery time,ICU hospitalization time,total hospitalization time,and postoperative short-term and long-term complications were compared between the two groups.Result The operation time and incision length of children in the study group were significantly better than those in the control group,and the difference between the two groups was small(P<0.05).There was little difference between the two groups in the incidence of complications such as pleural effusion,atelectasis,pneumonia,pulmonary abscess and arrhythmia(P>0.05);the number of patients with sternal deformity in the study group was far lower than that in the control group,and the difference between the two groups was small(P<0.05).Conclusion compared with the traditional median sternal incision,the lower sternal incision combined with cardiopulmonary bypass is less traumatic and less prone to sternal deformity in children’s congenital atrioventricular septal defect operation,which ensures the integrity and aesthetics of sternum,has better safety and stability,and effectively improves the clinical effect and prognosis of children.

关 键 词：胸骨下段小切口 胸骨正中切口 体外循环 房间隔缺损 室间隔缺损 微创手术 

分 类 号：R654.2[医药卫生—外科学]