胸腔镜辅助胸膜外动脉导管未闭结扎术临床价值研究

Clinical Study of Ligation of Patent Ductus Arterious with Video-assisted Thoracoscopic Surgery via Extrapleural Approach

【目的】探讨胸腔镜辅助胸膜外动脉导管未闭结扎术的临床应用价值。【方法】回顾性总结分析我院8年来实施胸腔镜辅助胸膜外动脉导管未闭结扎术51例患者的临床资料,并查阅近8年来国内外传统开胸PDA结扎术;腋下小切口PDA结扎术;胸腔镜PDA钳闭术及Amplatzer封堵器PDA封堵术的相关文献,对获得的相关临床资料与本术式进行对比分析。【结果】共查阅国内外相关文献351篇,各相关临床资料经统计学处理后,显示本术式与其他四种术式总并发症事件发生率比较,差异无统计学意义(P>0.05)。传统开胸PDA结扎术;腋下小切口PDA结扎术、胸腔镜PDA钳闭术、Amplatzer封堵器介入PDA封堵术和本术式的PDA治疗直径(mm)适应范围分别为2～20、3～16、3～10、4～12和2～20;治疗后残余分流率(%)分别为0.92～1.4、0～0.39、0.60～3.08、1.40～2.43、2.1;再次手术发生率(%)分别为0.39～0.91、0.39、0～2.31、0～0.59和0;年龄(岁)时应范围分别为0.9～56、5～24、1～36、3～60和1.5～38;住院日(d)分别为9～14、3～5、3～5、1～3和3～5;平均治疗费用(元)分别为12486、6042、9781、34169和10230;死亡率(%)分别为0～0.56、0、0、0和0。【结论】本术式疗效与常规开胸手术相同,但创伤小,恢复快;在PDA治疗直径和年龄适应范围较腋下小切口、单纯的胸腔镜手术及Amplatzer封堵术广,治疗费用明显低于Amplatzer封堵术。

[Objective] To study the clinical value of ligation of patent ductus arteriosus （PDA） via extrapleural approach.with video-assisted thoracoscopic surgery （VATS）. [Method] retrospective analysis of 51 cases underwent ligation of patent duetus arteriosus with VATS via extrapleural approach during the past 8 years. The above data were compared with data of literatures in civil and abroad about traditional ligation of PDA, ligation of PDA through subaxillary thoracotomy, VATS clamp of PDA and percutaneous traus-arterial/venous Amplatzer closure of PDA in 8 years respectively. [Results] 351 literatures had been reviewed in total. The comparison of extrapleural ligation of PDA with VATS with the other four methods had no statistical difference in incidence of complications （P 〉 0.05）. But,the suitable therapy diameters （mm） of traditional ligation of PDA, ligation of PDA through subaxillary thoracotomy, clamping of PDA with VATS, percutaneous Amplatzer closure of PDA and ligation of PDA with VATS via extrapleural approach were 2 ～ 20, 3 ～ 16, 3 ～ 10, 4 ～ 12, and 2 ～ 20, respectively. The incidence rates of residual shunt （%） were 0.92 ～ 1.4, 0 ～ 0.39, 0.60 ～ 3.08, 1.40 ～ 2.43, and 2.1, respectively. The suitable ages （y） were 0.9 ～56, 5 ～ 24, 1 ～ 36, 3 ～ 60, and 1.5 ～ 38, respectively. The average hospitalization time（d） was 9 ～ 14, 3 ～ 5, 3 ～ 5, 1 ～ 3, and 3 ～ 5, respectively. The therapy expenditure （￥） was 12 486, 6 042, 9 781, 34 169 and 10 230, respectively. The mortality （%） was 0 ～ 0.56, 0, 0, 0 and 0, respectively. [Conclusion] The effective was similar about both methods of extrapleural ligation of PDA with VATS and traditional ligation of PDA, but the method of extrapleural ligation of PDA with VATS was less injury; It was better than other ligationg method of PDA in suitable therapy diameter and suitable age. It was cheaper than the method of percutaneous Amplatzer PDA closure in expenditure.