微创右侧腋下小切口手术治疗简单先天性心脏病的疗效及安全性  

The efficacy and safety of minimally invasive right subaxillary small incision surgery for simple congenital heart disease

作　　者：霍莹 朱梦雅 刘刚 郭志鹏[1] 路万里[1] HUO Ying;ZHU Mengya;LIU Gang;GUO Zhipeng;LU Wanli(Department of Cardiac surgery,Teda International Cardiovascular Hospital,Tianjin 300457,China)

机构地区：[1]泰达国际心血管病医院心外科,天津300457

出　　处：《国际心血管病杂志》2024年第5期317-321,共5页International Journal of Cardiovascular Disease

基　　金：天津市滨海新区卫生健康委科技项目(2022BWKQ007)。

摘　　要：目的:探究微创右侧腋下小切口手术治疗简单先天性心脏病的疗效及安全性。方法:选取2019年1月1日至2022年10月1日于泰达国际心血管病医院行间隔类缺损修补术患儿250例,分为右腋下小切口组(研究组)125例及胸骨正中切口组(对照组)125例。比较2组手术相关指标[体外循环时间、主动脉阻断时间、手术时间、术后引流量、呼吸机使用时间、重症监护病房(ICU)停留时间]、应激指标[皮质醇、促肾上腺皮质激素(ACTH)]、神经损伤标志物[神经元特异性烯醇化酶(NSE)、中枢神经特异蛋白(S100β)]、炎症因子[肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6、C反应蛋白(CRP)]、临床疗效及并发症(胸口畸形、切口感染、纵隔感染)发生率。结果:研究组体外循环时间、主动脉阻断时间、呼吸机使用时间、ICU停留时间均短于对照组,并发症发生率低于对照组,治疗有效率高于对照组(P均<0.05)。2组术后1 d皮质醇、ACTH、NSE、S100β、TNF-α、IL-6、CRP水平均上升,且对照组皮质醇、ACTH、NSE、S100β、TNF-α、IL-6、CRP水平显著高于研究组(P均<0.05)。结论:微创右侧腋下小切口手术可能通过改善简单先天性心脏病患儿机体应激及炎症反应状态,减轻脑损伤,降低并发症发生风险。Objective:This study was conducted to explore the efficacy and safety of minimally invasive surgery for simple congenital heart diseases through small right axillary incision.Methods:Clinical data of 250 children who underwent septal defect repair at Teda International Cardiovascular Hospital from January 2019 to October 2022 were retrospectively analyzed.All operative procedures were performed through small right subaxillary incision(n=125,SRSI group)or conventional median sternotomy(n=125,CMS group).Procedurerelated parameters including cardiopulmonary bypass time,aortic blocking time,operation time,postoperative drainage,time of ventilator use,length of stay in Intensive Care Unit(ICU),stress indicators including cortisol,corticotropic hormone(ACTH),nerve injury markers including neuron-specific enolase(NSE),central nerve system specific protein S100β,and inflammatory factors including tumor necrosis factor(TNF)-α,interleukin(IL)-6,C-reactive protein(CRP),as well as clinical efficacy and incidence of complications(chest malformation,incision or mediastinal infection)were compared between the two groups.Results:Compared to CMS group,cardiopulmonary bypass time,aortic blocking time,time of ventilator use,and length of stay in ICU were shorter,complication rate was lower,and treatment response was better in SRSI group(all P<0.05).Although serum levels of cortisol,ACTH,NSE,S100β,TNF-α,IL-6,and CRP were increased one day after the procedure in both groups,these measurements were significantly reduced in SRSI group compared to CMS group(P<0.05).Conclusion:Our results suggest that minimally reduce surgery for congenital heart disease through small right subaxillary incision may reduce the stress and inflammatory response,reduce the risk of brain injury and complications.

关 键 词：微创右侧腋下小切口手术 传统开胸手术 简单先天性心脏病 临床疗效 

分 类 号：R654.2[医药卫生—外科学]