右腋下小切口手术对低龄低体质量的室间隔缺损合并动脉导管未闭及永存左上腔患儿的效果评估  

Evaluation of the safety and efficacy of right subaxillary small incision surgery in low-age and lowweight infants with ventricular septal defects and basal cardiac anomalies

作　　者：景小勇[1] 李论[1] 吴永涛[1] 王执一 段蔚然 王强[1] JING Xiaoyong;LI Lun;WU Yongtao;WANG Zhiyi;DUAN Weiran;WANG Qiang(Department of Pediatric Heart Center,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中心,100029

出　　处：《心肺血管病杂志》2024年第9期957-962,共6页Journal of Cardiovascular and Pulmonary Diseases

基　　金：首都卫生发展科研专项(首发2024-1-2062)。

摘　　要：目的:本研究旨在评估右腋下小切口手术对低龄低体质量的室间隔缺损(ventricular septal defects,VSD)伴心底部畸形患儿的安全性及有效性。方法:本研究纳入了2010年3月至2023年4月,于北京安贞医院小儿心脏中心接受外科治疗的126例低龄低体质量先天性心脏病患儿。全部患儿诊断为VSD合并心底部畸形(动脉导管未闭和/或者永存左上腔)。根据手术入路不同,将患儿分为右腋下小切口组(49例)和正中开胸组(77例)。对比分析两组患儿的术前情况、手术细节、围术期结果及远期随访数据。结果:两组患儿在围术期的关键生理指标上,差异无统计学意义,但右腋下小切口组在机械通气时间、ICU停留时间及住院时间上的表现更佳。远期随访显示,两组患儿的胸廓畸形发生率、生长发育和呼吸道疾病发生率,差异无统计学意义。结论:对于经验较丰富的医疗团队,应用右腋下小切口手术治疗低龄低体质量的VSD合并心底部畸形患儿,可取得与正中开胸手术相似的治疗效果,且具有创伤小、恢复快的优势。但应注意,对于动脉导管粗大或肺部发育不良的患儿,正中开胸手术可能更适宜。Objective:This study aims to evaluate the safety and efficacy of right subaxillary small incision surgery in low-age and low-weight infants with ventricular septal defects(VSD) accompanied by basal cardiac anomalies.Methods:The study included 126 low age and low-weight infants with congenital heart disease who underwent surgical treatment at the Pediatric Heart Center of Beijing Anzhen Hospital from March 2010 to April 2023.All subjects were diagnosed with VSD combined with basal cardiac anomalies(patent ductus arteriosus and/or persistent left superior vena cava).The patients were divided into two groups based on the surgical approach:the right subaxillary small incision group(49 cases) and the median sternotomy group(77 cases).Preoperative conditions,surgical details,perioperative outcomes,and long-term follow-up data were compared between the two groups.Results:There were no statistically significant differences in key perioperative physiological parameters between the two groups.However,the right subaxillary small incision group had shorter mechanical ventilation times,ICU stays,and hospital stays.Long-term follow-up revealed no significant differences in the rates of thoracic deformities,growth and development,and respiratory diseases between the groups.Conclusions:For experienced surgical teams,right subaxillary small incision surgery for treating low-age and low-weight infants with VSD and basal cardiac anomalies can achieve treatment outcomes similar to those of median sternotomy,with the advantages of less trauma and faster recovery.However,it should be noted that median sternotomy may be more appropriate for infants with large arterial ducts or poor pulmonary development.

关 键 词：先天性心脏病 右腋下小切口 低体质量 低龄 正中开胸 

分 类 号：R54[医药卫生—心血管疾病]