全胸腔镜与正中开胸房间隔缺损修补术临床对比研究

A Clinical Contrast Study on Total Thoracoscopic Surgery and Median Sternotomy in the Repair of Cardiac Atrial Septal Defect

目的比较全胸腔镜下房间隔缺损修补术与常规正中开胸手术的优缺点。方法对30例全胸腔镜下房间隔缺损修补术患者(胸腔镜组)和30例正中开胸术患者(正中开胸组)在主动脉阻闭时间、体外循环时间、手术时间、术后辅助呼吸时间、ICU停留时间、胸引量、输血量、术后住院时间、术后3d切口疼痛例数等方面的差异进行比较。结果两组患者入院时在年龄、体质量、性别、房缺大小、房缺类型、合并三尖瓣关闭不全或肺动脉高压等方面比较均无统计学差异(P>0.05)。两组患者在补片修补例数和三尖瓣成形例数方面无统计学差异(P>0.05),胸腔镜组手术的主动脉阻闭时间和体外循环时间稍长于正中开胸组(P<0.05),而该组患者的ICU停留时间、胸引量、输血量、术后住院时间、术后3d切口疼痛例数均少于正中开胸组(P<0.05);两组患者在手术时间和术后辅助呼吸时间方面没有统计学差异(P>0.05)。结论利用胸腔镜进行单纯房间隔缺损修补术的患者较正中开胸手术患者的住院时间更短,手术切口疼痛更少,恢复更快。

Objective To compare the merits and demerits of total thoracoscopic surgery（TTS） and median sternotomy（MS） in repairing cardiac atrial septal defect（ASD）. Methods In total, 60 patients with cardiac atrial septal defect were enrolled, 30 in TTS group and 30 in MS group; a comparative study was made to the aortic clams time extracorporeal circulation（ECC） time, operation duration,postoperative ventilation time, duration in ICU, the thoracic drainage, the amount of blood transfusion, postoperative hospitalization time and the case number of incision pain occurred 3 days after operation in the 2 groups and the difference was analyzed. Results There existed no statistical difference between the patients in the 2 groups in age, weight, sex, the size of ASD, the types of ASD and the case number with the complication of tricuspid insufficiency or pulmonary artery hypertension（P〉0.05）; no statistical difference was found between the case numbers of patch repair and tricuspid valvuloplasty in the 2 groups; the aortic clamp time and the ECC time in TTS group were slightly longer than those in MS group（P〈0.05） while the duration in ICU, the thoracic drainage, the amount of blood transfusion, postoperative hospitalization time and the case number of incision pain occurred 3 days after operation of the patients in TTS group were shorter or less than those of the patients in MS group（P〈0.05）; there existed no statistical difference between the postoperative ventilation time between the 2 groups（P〉0.05）.Conclusions Patients with ASD performed on by TTS have a shorter hospitalization time, less incision pain and quicker recovery than those by MS.