直视手术治疗成人房间隔缺损右外侧切口与正中切口的比较研究  

Comparison of right lateral incision and median incision in the treatment of adult atrial septal defect under direct vision

作　　者：吴永涛[1] 王栋[1] 金灿 王执一 杨尧[1] 程沛[1] 苏俊武[1] 范祥明[1] WU Yongtao;WANG Dong;JIN Can;WANG Zhiyi;YANG Yao;CHENG Pei;SU Junwu;FAN Xiangming(Department of Pediatric Cardiology,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所小儿心脏科,100029

出　　处：《心肺血管病杂志》2022年第4期391-393,398,共4页Journal of Cardiovascular and Pulmonary Diseases

基　　金：北京市自然科学基金(7202040)。

摘　　要：目的:本研究分析右外侧切口与正中切口治疗成人房间隔缺损(ASD),评价右外侧切口的治疗效果和注意事项。方法:2015年1月至2020年12月,ASD患者269例,男79例,女190例,年龄(33.5±11.5)岁,体质量(57.9±12.6)kg。根据切口的不同,分成右外侧切口组和正中切口组,比较右外侧切口与正中切口手术结果。结果:右外侧切口组ICU时间和术后住院时间明显比正中切口组短,差异有统计学意义(P<0.05)。在体外循环时间、主动脉阻断时间和机械通气时间上无明显差异。正中切口组术后心房颤动1例,清创2例,自发气胸1例,心包积液9例,胸腔积液3例。右外侧切口组心包积液6例。随访11~59个月,两组均未报告死亡或明显的残余缺陷及肺动脉高压。结论:右外侧切口直视手术治疗成人ASD具有良好的临床效果,虽然难度较高,但满足一定的条件可以成为成人ASD患者的主要选择。Objective:Right lateral incision in the treatment of simple congenital heart disease has been widely carried out in children,but less in adults.This study analyzed the treatment of adult atrial septal defect(ASD)with right lateral incision and median incision,and evaluated the therapeutic effect and development of right lateral incision.Methods:From January 2015 to December 2020,there were 269 patients with ASD,including 79 males and 190 females,aged(33.5±11.5)years and weight(57.9±12.6)kg.According to different incisions,they were divided into right lateral incision group and median incision group.The surgical results of right lateral incision and median incision were compared.Results:The ICU time and postoperative hospital stay in the right lateral incision group were significantly shorter than those in the median incision group(P<0.05).There was no significant difference in cardiopulmonary bypass time,aortic occlusion time and mechanical ventilation time.In the median incision group,there were 1 case of atrial fibrillation,2 cases of debridement,1 case of spontaneous pneumothorax,9 cases of pericardial effusion and 3 cases of pleural effusion.There were 6 cases of pericardial effusion in the right lateral incision group.Follow up for 11-59 months,no death or obvious residual defects and pulmonary hypertension were reported in both groups.Conclusions:the right lateral incision is a safe surgical incision,which has good clinical effect on adult ASD patients,and can be the choice of most adult ASD patients.

关 键 词：成人先天性心脏病 房间隔缺损修补 右外侧切口 

分 类 号：R54[医药卫生—心血管疾病]