右胸前外侧小切口与传统正中开胸治疗左心房粘液瘤的病例对照研究

Right anterolateral minithoracotomy versus traditional median sternotomy in left atrial myxoma treatment: A case control study

目的对比右胸前外侧小切口与传统正中开胸治疗左心房粘液瘤的安全性及临床效果。方法将我院2009年1月至2018年1月收治的41例左心房粘液瘤患者按照手术方式分为两组:右胸前外侧小切口组,15例,男7例、女8例,年龄(45.1±15.4)岁;正中开胸组,26例,男10例、女16例,年龄(49.4±11.9)岁。比较两组患者临床资料。结果两组患者术前临床资料差异无统计学意义。所有患者均顺利完成手术,围术期无死亡;右胸前外侧小切口组与正中开胸组的手术时间、体外循环时间和主动脉阻断时间以及术后相关并发症发生率差异无统计学意义,但右胸前外侧小切口组术后机械通气时间、住ICU时间和术后住院时间更短,术后24 h胸腔引流量和术后输血量更少,差异有统计学意义(P均<0.05);术后随访3～106个月,两组患者粘液瘤术后均无复发。结论与传统开胸左心房粘液瘤切除术比较,右胸前外侧小切口左心房粘液瘤切除术安全有效、创伤小,可作为左心房粘液瘤治疗的常规术式。

Objective To compare right anterolateral minithoracotomy and traditional median sternotomy in the treatment of left atrial myxoma.Methods Forty-one patients with left atrial myxoma treated in our hospital from January 2009 to January 2018 were divided into two groups according to the operation method:a right anterolateral minithoracotomy group including 15 patients,with 7 males and 8 females,aged 45.1±15.4 years;a median sternotomy group including 26 patients,with 10 males and 16 females,aged 49.4±11.9 years.The clinical data of the two groups were compared.Results There was no significant difference in preoperative clinical data between the two groups.All patients completed the operation without perioperative death.There was no significant difference in the operation time, cardiopulmonary bypass time,aortic clamp time or the incidence of postoperative complications between the two groups. However,compared with the median sternotomy group,the right anterolateral minithoracotomy group had shorter duration of mechanical ventilation,ICU stay and postoperative hospital stay,and less volume of drainage and blood transfusion 24 hours after surgery (all P<0.05).After 3-106 months follow-up,no recurrence was observed in both groups.Conclusion Compared with traditional median sternotomy for left atrial myxoma resection,right anterolateral minithoracotomy is safe,effective and less traumatic.It can be used as a routine treatment for left atrial myxoma.