小儿全胸腔镜与常规开胸室间隔缺损修补术的比较研究

Totally thoracoscopic surgery versus median sternotomy in ventricle septal defect treatment

目的通过与正中开胸室间隔缺损修补术比较,研究小儿全胸腔镜室间隔缺损修补术的安全性和优缺点。方法选取2004年7月～2005年8月53例行全胸腔镜下室间隔缺损修补术(TTS)和50例行正中开胸室间隔缺损修补术(MS)的小儿分为TTS组和MS组。比较两组间住院相关时间、肺功能以及血常规主要指标变化和出血、输血量。结果两组间在主动脉阻闭时间、住院时间和呼吸机辅助呼吸时间方面差异无显著性(P>0.05)。TTS组与MS组在术后早期的血红蛋白、白细胞及血小板的计数改变上差异无显著性(P>0.05)。TTS组手术时间长于MS组,而其ICU滞留时间短(P<0.01)。两组患儿手术后3个月复查肺功能指标与术前差异无显著性(P>0.05)。TTS组患儿手术后失血及输血量与MS组差异无显著性(P>0.05)。结论TTS可同MS一样安全、有效地进行室间隔缺损手术,且术后早期恢复快。

[Objective] To examine security and characteristic of totally thoracoscopic surgery（TTS）in ventricle septal defect treatment by comparison with median sternotomy（MS）. [Methods] From Jul 200d to Aug 2005, 53 patients（TTS group）aged from 1 to 1,4 were randomly sampled from TTS cases, while 50（MS group）from MS for pediatric ventricle septal defect. The clinical records from two groups were compared on hospital related time, variation of main data of blood routine test, pulmonary function, and blood loss and transfusion. [Results] The aortic clamp time, length of stay, ventilation time and variation of main data of blood routine test in Trs group had no significant difference to those in MS group （P〉0.05）. Operating times were longer in Trs group than in MS group, while TI＇S patients had shorter stays in the intensive care unit comparing to MS patients （P 〈0.01）. Preoperative and 3 months postoperative pulmonary function of both teams had no significant statistical difference （P〉0.05）. Blood transfusion and blood loss were not significantly different between two teams （P〉0.05）. [Conclusion] Trs is a safe and reliable method to pediatric ventricle septal defect disease as MS is and provides an earlier recovery.