全胸腔镜与传统开胸手术治疗膜周部室间隔缺损的对比研究

A Comparative Study Between Total Thoracoscopic and Conventional Thoracotomy in the Treatment of Perimembranous Ventricular Septal Defect

目的探讨全胸腔镜手术治疗膜周部室间隔缺损的临床疗效。方法回顾性分析2015年1月~2017年1月50例膜周部室间隔缺损的临床资料,其中全胸腔镜组21例,传统开胸组29例,比较2组体外循环时间、主动脉阻断时间、手术时间、胸腔引流量、使用血制品的例数、重症监护室停留时间、术后呼吸机辅助时间及住院时间。结果全胸腔镜组体外循环时间[(65.1±15.0)min vs.(49.0±10.7)min,t=4.435,P=0.000]和主动脉阻断时间[(47.3±12.2)min vs.(39.6±11.2)min,t=2.311,P=0.025]明显长于传统开胸组,胸腔引流量[(96.4±41.1)ml vs.(260.9±128.3)ml,t=-5.655,P=0.000]、术后使用血制品的例数[14.3%(3/21)vs.62.1%(18/29),χ~2=11.416,P=0.000]、住院时间[(5.3±1.1)d vs.(8.2±1.6)d,t=-7.161,P=0.000]明显少于/短于传统开胸组,2组手术时间、术后呼吸机辅助时间及ICU停留时间差异无统计学意义(P>0.05)。结论与传统开胸手术比较,胸腔镜下膜周部室间隔缺损修补术安全可靠,创伤小,恢复快,节约用血,可作为优先选择的术式。

Objective To evaluate the clinical efficacy of total thoracoscopic surgery for perimembranous ventricular septal defect （VSD）. Methods A retrospective analysis of clinical data of 50 cases of perimembranous ventricular septal defect from January 2015 to January 2017 was made. Among them, there were 21 cases of total thoracoscopic group and 29 cases of traditional thoracotomy group. The cardiopulmonary bypass （CPB） time, aortic clamping time, operation time, postoperative thoracic drainage, number of used blood products, postoperative hospital stay, postoperative ventilator assistance time and duration of intensive care unit stay were compared between the two groups. Results Compared with the traditional thoracotomy group, the total thoracoscopic group had prolonged CPB time [（65.1±15.0） min vs. （49.0±10.7） min, t =4.435, P =0.000], longer aortic clamping time [（47.3±12.2） min vs. （39.6±11.2） min, t =2.311, P =0.025], less postoperative thoracic drainage [（96.4±41.1） ml vs. （260.9±128.3） ml, t =-5.655, P =0.000], less postoperative use of blood products [14.3% （3/21） vs. 62.1% （18/29）, χ ^2 = 11.416, P =0.000], and shorter postoperative hospital stay [（5.3±1.1） d vs. （8.2±1.6） d, t =-7.161, P =0.000]. There was no statistically significant difference between the two groups in terms of operation time, postoperative ventilator assistance time, and duration of intensive care unit stay （ P 〉0.05）.Conclusions Compared with the traditional median thoracotomy, total thoracoscopic repair for perimembranous VSD is safe and reliable, with less trauma, quicker recovery, and less blood transfusion. It can be used as a preferred surgical intervention.