经胸腔镜修补房间隔缺损对体外循环全身炎症反应相关细胞因子表达的影响

Repair of atrial septal defect under total thoracoscope affected expression of systemic inflammatory factor after cardiopulmonary bypass

目的:比较完全胸腔镜下与常规开胸手术治疗先天性房间隔缺损的全身炎症反应程度。方法:40例房间隔缺损患者分为两组,电视胸腔镜组(A组)20例,采用右侧胸壁3孔,完全胸腔镜下完成手术;常规组(B组)20例,采用常规的正中纵劈胸骨,直视下修补房缺。比较两组的体外循环建立时间、体外循环转流时间、主动脉阻断时间、手术时间。用ELISA法检测不同时间点血清中肿瘤坏死因子α(TNF-α)、白介素(IL)-6、细胞间黏附因子1(ICAM-1)和IL-10水平。结果:手术全部成功,均无严重并发症发生。A组体外循环时间、主动脉阻断时间、体外循环建立时间和手术时间均显著长于B组。术后两组血清中TNF-α、IL-6、ICAM-1和IL-10水平较术前均显著升高,但A组回落迅速,且显著低于同期B组。结论:完全胸腔镜下手术治疗先天性房间隔缺损安全可行,全身炎症反应轻且平衡发展。

Objective：To evaluate the degree of systemic inflammatory response by compare the totally thoracoscopic operation with the conventional open operation to patients with atrial septal defect（ASD）.Methods：Total 40 ASD cases were divided into two groups,totally thoracoscopic group（group A,n = 20） and conventional open group（group B,n = 20）.In group A,surgical procedures were performed through three lateral-right chest wall holes under thoracoscopy.In group B,the arterial septal defects were repaired in the conventional way.Cardiopulmonary bypass（CPB） time,CPB setup time,aortic artery clamping time,operation time and serum levels of tumor necrosis factor α（TNF-α）,interleukin-6（IL-6）,intercellular adhesion molecule 1（ICAM-1） and interleukin-10（IL-10） in the two groups were compared.Results： All operation were performed successfully without serious complication.CPB time,CPB setup time,aortic artery clamping time and operation time in group A were statistically longer than those in group B.The serum levels of inflammatory factors（TNF-α,IL-6,ICAM-1,IL-10） in two groups statistically increased after surgery.The serum levels of inflammatory factors（TNF-α,IL-6,ICAM-1,IL-10） in group A were statistically lower than those in group B.Conclusion：Repair of ASD totally under thoracoscope ameliorats systemic inflammatory response.It is technically feasible,and safe.