全电视胸腔镜下先天性心脏病的外科治疗研究

Study of Surgical Treatment to Patients with Congenital Heart Disease under the Thoracoscope

目的随机比较胸腔镜下手术与传统开胸手术治疗先天性心脏病的临床疗效。方法随机将患者分为2组:腔镜组101例,采取股动静脉插管,建立体外循环,右胸胸壁打3个小孔后施行完全胸腔镜下手术;传统组103例,采用常规建立体外循环,平抑卧位,胸骨正中切口,纵劈胸骨手术。比较两组的静止呼吸顺应性(Cs)和动态肺顺应性(Cd)以及两组的体外循环时间、升主动脉阻断时间、手术时间、术后呼吸机辅助呼吸时间、胸腔引流量、术后住院时间及外科治疗效果。结果体外循环时间、升主动脉阻闭时间、手术时间、术后呼吸机辅助呼吸时间及外科治疗效果两组无显著性差异。但胸腔引流量、术后住院时间、Cs和Cd两组有显著性差异。结论全胸腔镜下治疗先天性心脏病创伤小、住院时间短、美容,具有很好的临床应用价值。

OBJECTIVE To compare the clinical curative effect of surgical treatment to patients with congenital heart disease（CHD） under the thoracoscopic operation with the traditional open heart operation. METHODS 204 patients were randomly divided into 2 groups： thoracoscopic group （ 101 cases） and tranditional group （ 103 cases）. In the thoracoscopic group, extracorporeal circulation （ECC） was established with femoral artery and femoral vein cannulas, and operation was completed under the thoracoscope through three small holes on the right chest wall. While in the tranditional group, ECC and operation were performed in the usual way. The patients＂ static respiration complaisance （ Cs）, dynamic respiration complaisance （ Cd）, ECC time, aortic artery clamping time, operation time, postoperative respirator assisting time, thoracic drainage volume, postoperative time in hospital and clinical curative effect in the two groups were compared. RESULTS There were no significant differences between two groups except for the thoracic drainage volume, postoperative time in hospital, Cs and Cd （ P 〈 0.05）. CONCLUSION Surgical treatment to the CHD patients under the thoracoscope has more clinical applying advantages, such as the slighter trauma, shorter time in hospital and more beautiful outlook than the traditional open heart operation.