不同入路房间隔缺损修补术后患者心脏结构近期改变的比较

Short-term cardiac structural changes after atrial septal defect repair via different approaches

目的比较不同入路房间隔缺损修补术后患者心脏结构的近期改变。方法选取房间隔缺损修补术患者104例,根据入路方式分为左房微小切口组、右外侧切口组和正中切口组。比较各组体外循环时间、机械通气时间、术后引流量、术后住院时间、切口长度、重症监护时间、心脏结构变化及并发症情况。结果与正中切口组比较,左房微小切口组和右外侧切口组机械通气时间、术后住院时间、重症监护时间、切口长度缩短,术后引流量减少(P<0.05)。与术前比较,术后各组右房左右径和上下径、右室前后径缩小,左室舒张期末内径增大(P<0.05),且术后3个月较术后3天比较差异更显著(P<0.05),术后3天左房微小切口组和右外侧切口组与正中切口组比较差异更显著(P<0.05);术后3个月各组上述指标比较差异无显著性(P>0.05)。各组并发症比较差异无显著性(P>0.05)。结论左房微小切口、右外侧切口较正中切口入路房间隔缺损修补术近期矫正效果较好,但应根据患者实际情况选择合适术式。

Aim To compare the short-term cardiac structural changes after atrial septal defect repair via different approaches.Methods One hundred and four patients underwent atrial septal defect repair were selected and assigned into left lateral mini-incision group,right lateral incision group and median incision group according to the surgical approaches.Cardiopulmonary bypass time,mechanical ventilation time,postoperative drainage,postoperative length of stay,incision length,intensive care unit time,cardiac structural changes and complications among different groups were compared.Results Compared with median incision group,left lateral mini-incision group and right lateral incision group showed a shorter mechanical ventilation time,postoperative length of stay,and intensive care unit time and incision length,and lower postoperative drainage volume,with statistical difference(P<0.05).Compared with preoperative conditions,the diameter of the right atrium and right ventricle decreased and the end diastolic diameter of the left ventricle increased in each group after surgery(P<0.05),and the difference was more significant at 3 months after surgery compared to 3 days after surgery(P<0.05),while no statistical difference was found among three groups at postoperative 3 months(P>0.05).The complication rate demonstrated no statistical difference among three groups(P>0.05).Conclusion The left lateral mini-incision and right lateral incision are better than the median approach for repairing atrial septal defect in the short term,but the appropriate surgical approach should be selected according to the actual situation of patients.