不同手术方式治疗动脉导管未闭的疗效分析

Analysis of theraperutic effects of different surgicul metheods for patent ductus arteriosus

目的探讨传统左后外侧切口动脉导管结扎术、电视胸腔镜下动脉导管结扎术、改良腋下小切口动脉导管结扎术治疗动脉导管未闭(patent ductus arteriosus,PDA)的疗效。方法回顾性分析2018年2月至2020年12月新疆医科大学第一附属医院小儿心胸外科收治的PDA患儿临床资料,根据手术方式分为A、B、C三组,A组采取传统经左后外侧切口动脉导管结扎术,B组采取电视胸腔镜下动脉导管结扎术,C组采取改良腋下小切口动脉导管结扎术。本研究纳入PDA患儿119例,其中A组41例(男16例,女25例)、B组37例(男19例,女18例)、C组41例(男17例,女24例)。比较三组患儿手术时间、术中出血量、切口长度、术后胸腔闭式引流量、重症监护室(Intensive Care Unit,ICU)滞留时间、胸腔闭式引流时间、术后住院时间及并发症发生率。结果A、B、C三组患儿手术时间[(112.20±26.41)min、(104.51±18.59)min、(114.39±33.28)min]差异无统计学意义(P>0.05)。A、B两组术后留置胸腔闭式引流管,B组术后胸腔引流量少于A组[(69.05±23.95)mL比(109.76±37.18)mL],引流时间短于A组[(3.24±0.93)d比(4.66±2.67)d],差异均有统计学意义(P<0.05);C组未留置胸腔闭式引流管。在切口长度、术中出血量、术后住院时间、ICU滞留时间及气管插管时间上比较,B组均短于或少于A组,C组均短于或少于B组,差异均有统计学意义(P<0.05)。患儿返回病房后1 h、12 h、24 h的FLACC疼痛评分比较,A组均高于B组,B组均高于C组,差异均有统计学意义(P<0.05)。三组术后均无一例残余分流、乳糜胸发生;C组出现少量胸腔积液1例,轻度气胸1例;A组出现肺不张4例,肺部感染5例;B组出现肺不张5例,肺部感染5例;A、B两组并发症发生率均高于C组,差异均有统计学意义(P<0.05)。结论腋下小切口动脉导管结扎术治疗PDA创伤小,恢复快,美容效果好,并发症少,可作为临床首选方法之一。

Objective To explore the efficacy of traditional ligation of patent ductus arteriosus(PDA)through left posterolateral incision,video-assisted thoracoscopic closure of PDA and modified ligation of PDA through axillary small incision.Methods From February 2018 to December 2020,clinical data were retrospectively reviewed for 119 PDA children.According to different surgical approaches,they were divided into three groups of A,B and C.Group A underwent traditional ligation of PDA through left posterolateral incision,group B video-assisted thoracoscopic closure of PDA and group C modified axillary small incision ligation of PDA.Operative duration,volume of blood loss,incision length,postoperative closed chest drainage volume,ICU retention time,closed chest drainage removal time,postoperative hospitalization stay and incidence of complications were recorded.Results There were 16 boys and 25 girls in group A,19 boys and 18 girls in group B and 17 boys and 24 girls in group C.Among groups A,B and C,no statistical differences existed in operative duration(112.20±26.41,104.51±18.59,114.39±33.28 min)or complications(9,10,2)(P>0.05):volume of blood loss(18.12±13.69,11.73±9.15,10.68±7.08 ml),incision length(8.98±0.94,4.05±0.48,2.38±0.31 cm),volume of closed chest drainage(109.76±37.18,69.05±23.95),removal time of closed chest drainage(4.66±2.67、3.24±0.93 day).No closed chest irrigation in group c.Tracheal intubation time(7.68±1.77,6.81±2.38,5.66±1.51 h),ICU retention time(42.78±21.62,39.94±14.48,29.39±12.94 h),postoperative hospitalization stay(6.17±1.80,5.54±1.92,4.56±0.92 day),FLACC score(facial expression,legs,activity,cry&consolability)T1(6.63±0.70,5.97±0.93,4.73±1.03),T2(5.66±0.83,5.19±0.81,3.20±0.98),T3(5.07±0.75,4.51±0.84,2.83±1.09).Group B was less than group A and group C less than group B.The differences were statistically significant(P<0.05).Conclusions Small axillary incision ligation of PDA is preferred due to minimal trauma,quicker recovery,excellent cosmetics and fewer complications.