胸腔镜与开胸手术治疗先天性心脏病的疗效比较

A comparison between thoracoscopic and open cardiac surgery in the treatment of congenital heart diseases

目的比较胸腔镜与开胸手术治疗先天性心脏病的疗效。方法将62例先天性心脏病,根据患者的手术选择意愿分为2组。胸腔镜组24例,采用体外循环技术,胸腔镜下行房间隔缺损修补术8例,室间隔缺损修补术16例;开胸组38例,直视下行房间隔缺损修补术14例,室间隔缺损修补术24例。结果2组均无死亡。2组体外循环时间[(74±28)minvs.(71±24)min]、升主动脉阻闭时间[(29±13)minvs.(28±12)min]、术后呼吸机辅助时间[(3.2±1.1)hvs.(3.3±1·1)h]无显著性差异(t=0·449、0·309、-0·349;P=0·655、0·758、0·729)。2组术后并发症发生率无显著差异(χ2=2·646,P=0·104)。与开胸组比较,胸腔镜组术后胸腔引流量明显减少[(32±18)mlvs(66±28)ml;t=-5·290,P=0·000],术后住院时间明显缩短[(6·1±1·2)dvs.(7·6±2·2)d;t=-3·059,P=0·003]。结论胸腔镜手术治疗先天性心脏病创伤小,恢复快,美容效果好,安全可靠。

Objective To compare the efficacy between thoracoscopic and open cardiac surgery in the treatment of congenital heart diseases. Methods A total of 62 patients with congenital heart diseases were divided into two groups according to patients＇ preference. There were 24 patients in the Thoracoscopic Group. The thoracoscopic operations were performed under extracorporeal circulation, including atrial septal defect repair in 8 patients and ventricular septal defect repair in 16 patients. The Open Group consisted of 38 patients, including atrial septal defect repair in 14 patients and ventricular repair in 24 patients. Results Fatal cases happened in neither of groups. There were no significant differences between the two groups in the bypass time （74±28 min vs 71±24 min; t =0.449, P =0.655）, the ascending aorta cross -clamping time （29±13 rain vs 28±12 min; t =0.309, P =0. 758 ） , and the postoperative mechanical ventilation time （3.2± 1.1 h vs 3.3± 1.1 h ;t = - 0. 349, P = 0.729 ） , respectively. No significant variation in incidence of postoperative complications was observed between the two groups （X^2 = 2. 646,P = 0. 104）. As compared with the Open Group, the Thoracoscopic Group had a significantly less chest drainage volume （32±18 ml vs 66±28 ml;t = - 5. 290,P = 0. 000） and a significantly shorter postoperative hospital day （ 6.1±1.2 d vs 7.6±2.2 d ;t = - 3. 059,P = 0. 003 ）.Conclusions Thoracoscopic cardiac surgery for congenital heart diseases is a safe and effective technique with little invasion, quick recovery and good cosmetic results.