体外循环下直视微创与传统正中开胸的房间隔缺损手术治疗的对比:倾向性评分匹配研究

Comparison of short-term surgical outcomes between minimally invasive versus conventional sternotomy in atrial septal defect closure procedure: a propensity score analysis

目的:通过倾向性评分,对比匹配法均衡评价直视微创与传统正中开胸体外循环房间隔缺损手术治疗的效果。方法:选取2005年6月至2013年3月,在北京安贞医院行单一体外循环下房间隔缺损修补手术的291例患者,其中48例(16.5%)为直视微创下手术患者,其余242例(83.5%)为传统正中开胸方式。根据倾向性评分匹配方法,在242例患者中选取48例成为对照组,与微创组进行对比研究。结果:经倾向性评分匹配后,相对于传统正中开胸房间隔修补手术,直视微创组在手术时间[(3.5±0.7)vs.(3.7±1.8)小时,P=0.547],体外循环时间[(73.0±30.0)vs.(87.3±36.1)分钟,P=0.126],主动脉阻断时间[34.1(15.3,45.9)vs.34.9(16.1,48.2)分钟,P=0.200],驻重症监护室(ICU)时间[15.6(5.9,18.8)vs.21.7(8.6,25.8)小时,P=0.153]等方面差异无统计学意义,而在手术后住院时间[(5.54±2.3)vs.(8.85±2.06)天,P=0.021],术后引流量[457(110,673)vs.801(389,1 173)m L,P=0.011,输血率[18.8%vs.87.5%,P=0.000],手术切口长度等方面差异有统计学意义。结论:在跨越了学习曲线后,直视微创房间隔缺损修补手术比传统正中开胸手术有诸多优势,是安全,有效,易于推广的手术方式。

Objective： To investigate the feasibility and safety of minimally invasive closure for atrial septal defect compared to conventional sternotomy procedure. Methods： In a retrospective,observational,cohort study of prospectively collected data on 291 consecutive patients with atrial septal defect disease underwent isolated closure procedure（ 48,16. 5%,minimally invasive vs 242,83. 5%,conventional sternotomy） between June2005 and March 2013 at Beijing Anzhen hospital. 48 patients underwent minimally invasive closure procedure（ MI group） were matched with 48 patients underwent conventional sternotomy procedure（ CS group） by propensity score. Results： After propensity matching,groups were comparable in preoperative characteristics. Relative to CS group,MI group was associated with lower in the stay time of post-operative hospital（ 5. 54 ± 2. 3） vs.（ 8. 85 ± 2. 06） days（ P = 0. 021）,postoperative drainage457（ 110,673） vs. 801（ 389,1173） mL（ P =0. 011）,the ratios of perioperative blood transfusion 18. 8% vs. 87. 5%（ P = 0. 000） and the length of surgical incision（ 4. 5 ± 0. 7） vs.（ 22. 3 ± 1. 5） cm（ P = 0. 000）. Then,the two grups had no significant statistical differences in operation time（ 3. 5 ± 0. 7） vs（ 3. 7 ± 1. 8） hours（ P = 0. 547）,cardiopulmonary bypass time（ 73. 0 ±30. 0） vs.（ 87. 3 ± 36. 1） minutes（ P = 0. 126）,aortic clamping time 34. 1（ 15. 3,45. 9） vs. 34. 9（ 16. 1 ±48. 2） minutes（ P = 0. 200）,stay in the intensive care unit（ ICU） time 15. 6（ 5. 9,18. 8） vs. 21. 7（ 8. 6,25. 8） hours（ P = 0. 153）. Conclusion： Minimally invasive Atrial septal defect closure procedure can be per-formed safely as conventional stermotomy procedure. Patients underwent this technique were not exposed to an increased operative risk.