经右胸前外侧小切口体外循环修补术与经胸部正中切口体外循环修补术治疗房间隔缺损的疗效对比分析

Comparative Analysis of Efficacy of Cardiopulmonary Bypass Repair with Right Anterolateral Thoracotomy Incision and Cardiopulmonary Bypass Rpair with Transthoracic Median Incision in the treatment of Atrial Septal Defect

目的:分析比较经右胸前外侧小切口体外循环修补术与经胸部正中切口体外循环修补术治疗房间隔缺损的临床疗效。方法:回顾性分析经右胸前外侧小切口体外循环修补术治疗(右小切口组)及经胸部正中切口体外循环修补术治疗(正中切口组)的房间隔缺损患者各46例临床资料。记录两组术中情况、术后恢复情况、术后并发症发生情况及患者满意度状况,并比较两组术前及术后6个月身体意象状态、生活质量差异。结果:两组术中体外循环时间、主动脉阻断时间比较,差异无统计学意义(P>0.05);但右小切口组术中出血量、切口长度及右小切口组术后机械通气时间、术后重症监护时间、胸腔引流量、术后住院时间均低于正中切口组(P<0.05)。两组术后并发症发生情况比较,差异无统计学意义(P>0.05)。右小切口组患者满意度明显优于正中切口组(P<0.05)。术后6个月时,两组BISS评分均较术前升高(P<0.05),但正中切口组高于右小切口组(P<0.05);两组QLI评分也较术前升高(P<0.05),但右小切口组高于正中切口组(P<0.05)。结论:经胸部正中切口与经右胸前外侧小切口体外循环修补术治疗房间隔缺损均具有较好疗效及安全性,但右胸前外侧小切口术式在降低手术创伤、促进术后康复、改善术后生活质量及身体意象方面更具有优势,还能提升患者满意度。

Objective: To analyze and compare the clinical efficacy of cardiopulmonary bypass repair with right anterolateral thoracotomy incision and cardiopulmonary bypass repair with transthoracic median incision in the treatment of atrial septal defect. Methods: The clinical data of each 46 patients with atrial septal defect treated by cardiopulmonary bypass repair with right anterolateral thoracotomy incision(right small incision group) and cardiopulmonary bypass repair with transthoracic median incision(median incision group) were retrospectively analyzed. The intraoperative conditions, postoperative recovery, occurrence of postoperative complications and patient satisfaction were recorded in the two groups, and the body image status, and quality of life were compared between the two groups before operation and at 6 months after operation. Results: There were no significant differences in the intraoperative cardiopulmonary bypass time and aortic crossclamp time between the two groups(P>0.05). However, the intraoperative blood loss, incision length and mechanical ventilation time, postoperative intensive care time, chest drainage volume and postoperative hospital stay in right small incision group were lower than those in median incision group(P<0.05). There was no significant difference in the occurrence of postoperative complications between the two groups(P>0.05). The patient satisfaction in right small incision group was significantly better than that in median incision group(P<0.05). At 6 months after operation, the BISS scores in the two groups were higher than those before operation(P<0.05), but the score in median incision group was higher than that in right small incision group(P<0.05). The QLI scores in the two groups were also higher than those before operation(P<0.05), but the score in right small incision group was higher than that in median incision group(P<0.05). Conclusion: Cardiopulmonary bypass repair with transthoracic median incision and cardiopulmonary bypass repair with right anterolateral thoracotomy incision both have good efficacy and safety in the treatment of atrial septal defect. However, right anterolateral thoracotomy incision procedure is more advantageous in reducing the surgical trauma, promoting postoperative rehabilitation and improving postoperative quality of life and body image, and it can improve patient satisfaction.