胸骨左缘肋间入路干下型室间隔缺损修补术的相关性研究  

Study of the correlation between left intercostal sternal approach and subarterial ventricular septal defect repair

作　　者：罗洪波[1] 蒋振威[1] 张文斌[1] 李永红[2] Luo Hongbo;Jiang Zhenwei;Zhang Wenbin;Li Yonghong(Department of Cardiac Surgery,Guizhou Provincial People′s Hospital,Guiyang 550003,China;Department of Operating Room,Guizhou Provincial People′s Hospital,Guiyang 550003,China)

机构地区：[1]贵州省人民医院心脏外科,贵阳550003 [2]贵州省人民医院手术室,贵阳550003

出　　处：《中国临床实用医学》2023年第2期6-10,共5页China Clinical Practical Medicine

基　　金：2022年度贵州省卫生健康委科学技术基金项目(gzwkj2022-095);贵州省科技计划项目(黔科合LH字[2016]7181)。

摘　　要：目的探讨胸骨左缘肋间入路行干下型室间隔缺损修补术的适应证、方法、可行性及优势。方法本研究为病例对照研究,选取2015年1月至2019年10月贵州省人民医院心脏外科收治的138例行干下型室间隔缺损修补术患者,男85例,女53例,年龄(11.10±0.80)岁,年龄范围为6~17岁。根据手术方式不同将患者分为正中开胸入路组(n=75)与胸骨左缘入路组(n=63),比较两组患者术中相关指标、术后检测指标、术后3 d心、肺、肾相关检查指标及并发症发生情况。结果胸骨左缘入路组患者手术时间[(96.30±1.50)min]、体外循环时间[(47.70±0.80)min]、主动脉阻断时间[(17.60±0.40)min]、术后引流量[(113.60±5.40)ml]、呼吸机使用时间[(7.71±0.15)h]、ICU停留时间[(16.43±0.22)h]均少于开胸入路组[(105.80±1.40)min、(49.20±0.90)min、(18.70±0.40)min、(141.50±5.50)ml、(8.71±0.19)h、(18.10±0.39)h],差异均有统计学意义(P<0.05)。胸骨左缘入路组患者术后3 d丙氨酸氨基转移酶[(19.70±0.60)U/L]、总胆红素[(13.94±0.68)μmol/L]、血肌酐[(60.31±1.02)μmol/L]均低于正中开胸入路组[(26.29±0.66)U/L、(16.93±0.49)μmol/L、(61.76±0.93)μmol/L],左室射血分数[(58.05±0.36)%]高于正中开胸入路组[(55.52±0.40)%],差异均有统计学意义(P<0.05)。正中开胸入路组并发症发生率[8.0%(6/75)]与胸骨左缘入路组[0%(0/63)]比较,差异无统计学意义(P>0.05)。结论胸骨左缘肋间入路行干下型室间隔缺损修补术创伤小、恢复快、手术效果确切,适合于可心外插管建立体外循环的患者。Objective To explore the indications,methods,feasibility and advantages of subarterial repair by intercostal approach at left sternal margin.Methods This study was a case-control study,a total of 138 patients who underwent subtrunk ventricular septal defect repair in department of Cardiac Surgery of Guizhou Provincial People′s Hospital from January 2015 to October 2019,including 85 males and 53 females,aged(11.10±0.80)years old,and the age range was 6 to 17 years old.According to the different surgical methods,the patients were divided into the median thoracotomy group(n=75)and the left sternal border approach group(n=63),and the intraoperative indexes,postoperative detection indicators,heart,lung and kidney-related examination indexes and complications of the two groups were compared.Results The operation time[(96.30±1.50)min],extracorporeal bypass time[(47.70±0.80)min],aortic occlusion time[(17.60±0.40)min],postoperative drainage[(113.6±5.4)ml],ventilator use time[(7.71±0.15)h],ICU residence time[(16.43±0.22)h]in the left sternal border approach group were lower than those in the median thoracotomy group[(105.80±1.40)min,(49.20±0.90)min,(18.70±0.40)min,(141.5±5.5)ml,(8.71±0.19)h,(18.10±0.39)h],the differences were statistically significant(P<0.05).The 3 days after the operation,alanine aminotransferase[(19.70±0.60)U/L],total bilirubin[(13.94±0.68)μmol/L],serum creatinine[(60.31±1.02)μmol/L]in the left sternal border approach group were lower than those in the median thoracotomy group[(26.29±0.66)U/L,(16.93±0.49)μmol/L,(61.76±0.93)μmol/L],left ventricular ejection fraction[(58.05±0.36)%]in the left sternal border approach group was higher than that in the median thoracotomy group[(55.52±0.40)%],the differences were statistically significant(P<0.05).The incidence of complications in the median thoracotomy group[8.0%(6/75)]was compared with that in the left margin sternum group[0%(0/63)],and the difference was not statistically significant(P>0.05).Conclusions The left intercostal sternal

关 键 词：胸骨左缘 肋间隙 正中开胸 室间隔缺损 干下型室间隔缺损修补术 

分 类 号：R726.5[医药卫生—儿科]