胸腔镜与常规开胸治疗动脉导管未闭疗效比较

Comparison of Video-assisted Thoracoscopic Surgery and Conventional Thoracotomy in Management of Patent Ductus Arteriosus

报道４５例在胸腔镜下完成动脉导管闭合手术的病例。其中男２１例，女２４例。平均年龄１６．６岁（２～３６岁），体重６～５３ｋｇ。手术在全麻下进行，行单侧肺通气，然后在左侧胸壁上选择３个长约１ｃｍ的切口，用于放入摄像镜头及手术操作器械。在镜下用丝线结扎导管；提起结扎线后，再用钛夹钳闭导管。丝线结扎导管非常重要，可以有效地防止因单用钛夹发生滑脱造成导管再通。本组无手术死亡及并发症，特别是导管再通的发生。将这组病人与以前开胸下导管结扎术病人做比较，显示胸腔镜手术具有创伤小、出血少、疼痛轻、恢复快及用药少等优点。并且适用于各种年龄、体重及肺动脉高压的病人。结论：胸腔镜下动脉导管未闭结扎是一种安全。

Aim:To compare the results of video-assisted thoracoscopic surgery(VATS)and conventional open thoracotomy in the treatment of patent ductus arteriosus(PDA).Clinical material and method:From March 1994 to March 1996,45 patients with PDA underwent VATS procedures.There were 21 males and 24 females.The mean age of patients was 16.6 years(range 2 to 36 years).The results of VATS was compared to 35 patients with PDA treated by conventional open thoracotomy.Result:There were no operative mortality and no postoperative complications in VATS group.The mean operating time was 86.0±12.6 minutes for VATS group and 84.0±10.3 minutes for open group(P>0.05).The mean duration of chest drainage was 24.0±6.3 hours for VATS group and 36.0±7.3 hours (P<0.01).The mean hospital stay after surgery was 9.2±2.3 days for VATS group and 12.0±3.1 days for open group.The difference between two groups was significant(P<0.01).Conclusion:VATS should be considered as the approach of choice for PDA.