完全胸腔镜与正中开胸治疗心脏粘液瘤的病例对照研究

Totally Thoracoscopic Surgery versus Median Sternotomy in Cardiac Myxoma Treatment

目的 探讨完全胸腔镜手术治疗心脏粘液瘤的安全性、可行性及优越性。方法 回顾性分析我科2001年1月至2015年11月间收治的331例心脏粘液瘤患者的临床资料。依据手术方式将患者分为两组：完全胸腔镜组,完全胸腔镜下行心脏粘液瘤摘除术196例,男71例、女125例,年龄50（42.00-57.50）岁;正中开胸组,传统正中胸骨切口心脏粘液瘤摘除术135例,男53例、女82例,年龄52（38.00-61.00）岁。比较两组间手术创伤程度指标、术后恢复速度指标及并发症发生率等。结果 331例患者均完成手术。在输血量（P〈0.001）、引流量（P〈0.001）、疼痛评分（P〈0.001）、呼吸机辅助时间（P〈0.001）及ICU恢复时间（P=0.001）及并发症发生率（P〈0.001）方面完全胸腔镜组少于或短于开胸组,且差异有统计学意义;两组主动脉阻断时间差异无统计学意义（P=0.15）,但在体外循环转流时间上胸腔镜组更长（P〈0.001）。结论 完全胸腔镜治疗心脏粘液瘤安全有效,与正中开胸手术比较,在创伤、引流量、输血量、术后疼痛、并发症及恢复时间方面更有优势,对患者美容、心理等方面的影响小。

Objective To examine the differences between totally thoracoscopic surgery and median sternotomy in scope of trauma, postoperative recovery and postoperative complications. Methods We retrospectively analyzed the clinical data of 331 patients with cardiac myxoma in our hospital between January 2001 and November 2015. The patients were devided into 2 groups by the different methods of operation： a totally thoracoscopic surgery group including 196 patients with 71 males and 125 females at a mean age of 50 （42.00-57.50） years, and a median sternotomy group including 135 patients, with 53 males and 82 females at a mean age of 52 （38.00-61.00） years. The clinical records of the two groups were compared in scope of trauma, postoperative recovery, and postoperative complications. Results There was shorter time in breathing machine and ICU time （P〈0.001）, and fewer volume in blood transfusion, blood loss （P〈0.001） in the totally thoracoscopic surgery group. There was less pain and postoperative complications （P〈0.001） in the totally thoracoscopic surgery group. The aortic clamp time in the totally thoracoscopic surgery group was not significantly different compared with that in the median sternotomy group （P=0.15） While cardiopulmonary bypass time was shorter in the median sternotomy group （P〈0.001）. Conclusion Totally thoracoscopic surgery is a safe and reliable method in treating cardiac myxoma. Our results suggest that totally thoracoscopic surgery has the advantage of fewer blood loss, blood transfusion, and postoperative complications compared with median sternotomy surgery. Totally thoracoscopic surgery leads to earlier recovery and less pain.