右外侧小切口室间隔缺损修补术疗效及生活质量研究

Outcomes and Life Quality of Patients Undergone VSD Repair by a Shorter Right Lateral Thoracotomy

目的评价右外侧小切口室间隔缺损修补术的疗效及术后生活质量。方法488例调查年龄为6-15岁的右外侧小切口室间隔缺损修补术为右侧组,随机抽取同期185例调查年龄为6-15岁的正中开胸室间隔缺损修补术为正中组。比较2组近期疗效、远期疗效和术后健康相关生活质量,近期疗效指标包括体外循环时间、心肌阻断时间、术后胸液量、院内死亡、并发症情况及术后住院时间,远期疗效指标包括远期症状、体征、超声心动图、胸片、心电图检查结果,术后健康相关生活质量以中文版TACQOL（TNO-AZL Children’s Quality of Life）量表评价。结果右侧组胸液量明显少于正中组[（106.7±85.2）ml vs.（146.7±75.6）ml,t=5.603,P=0.000]。2组体外循环时间、主动脉阻断时间、术后住院时间、院内死亡率、并发症发生率无统计学显著性差异（P〉0.05）。2组鸡胸发生率[0 vs.1.6%（3/185）,χ^2=413.041,P=0.000]、TACQOL量表中身体状况[（29.6±2.8）分vs.（28.1±3.0）分,t=4.843,P=0.000]、运动功能[（31.2±1.1）分vs.（30.5±1.6）分,t=5.139,P=0.000]、自理能力[（31.9±0.4）分vs.（31.6±0.8）分,t=5.130,P=0.000]、认知能力[（29.9±3.2）分vs.（26.9±4.2）分,t=7.902,P=0.000]、积极情绪[（13.4±2.2）分vs.（12.6±2.1）分,t=3.394,P=0.000]差异显著,右侧组优于正中组。远期疗效的其他指标和TACQOL量表中其他维度2组间无统计学显著性差异（P〉0.05）。结论右外侧小切口室间隔缺损修补术疗效满意,术后生活质量更佳。

Objective To evaluate the early and late outcomes of repair of congenital ventrieular septal defects by shorter right lateral thoraeotomy and the postoperative life quality of the patients. Methods Totally 488 patients with isolated congenital ventricular septal defects （aged 6 - 15 years） undergone repair surgery by right lateral thoracotomy via a small incision between October 1994 and April 2004 were surveyed as Right Group, while 185 same age cohorts undergone this repair through a median sternotomy simultaneously as Median Group. Cardiopulmonary bypass time, aortic cross-clamping time,amount of drainage, postoperative hospital stay, in-hospital mortality and morbidity were measured as early outcomes. Symptoms and physical signs related with primary disease and the outcome of ultrasonic cardiogram, chest film and electrocardiogram were followed up as late outcomes; meanwhile the patients ＂TACQOL questionnaires completed by their parents were studied to evaluate the health-related quality of life. The two groups＇early and late outcomes and scores of TACQOL were compared with each other. Results Compared with Median Group, Right Group＇ s early and late outcomes were more satisfactory with less amount of drainage [ （106.7 ±85.2） ml vs. （146.7 ±75.6） ml, t = 5. 603, P = 0. 000] . There were no statistical difference in cardiopulmonary bypass time, aortic cross-clamping time, postoperative hospital stay, in-hospital mortality and morbidity between the two groups （ P 〉 0.05 ）. Right Group had lower incidence of pigeon chest compared with that of Median Group [ 0 vs. 1.6% , Х^2 = 413. 041 ,P = 0. 000 ]. The scores of TACQOL questionnaire of Right Group were higher than that of Median Group in the domains ＂Physical Complaints＂ [（29.6 ±2.8） vs. （28. 1 ±3.0）, t =4.843,P=0.000], ＂Motor Functioning＂ [（31.2±1.1） vs. （30.5±1.6）, t=5.139, P=0.000] and ＂Cognitive Functioning＂ [（29.9±3.2 ） vs. （26.9±4.2） , t = 7. 902, P = 0. 000 3. Conclusions The repair surgery of ventricular septal defects through a shorter right lateral thoracotomy can provide superior early and late outcomes and better health-related quality of life for pediatric patients.