右腋下垂直切口在儿童室间隔缺损修补术中的效果分析

Effect of right vertical infra-axillary thoracotomy on the repair of ventricular septal defect in children

目的探讨右腋下垂直切口开胸(RVIAT)在儿童室间隔缺损(VSD)修补术中的安全性及RVIAT最佳手术年龄。方法回顾性分析2014年6月至2018年6月于我院经RVIAT行VSD修补术的441例患者的临床资料,根据年龄将患者分为4组:4个月至1岁组(R1组,n=123)、1~2岁组(R2组,n=106)、2~5岁组(R3组,n=166)和>5岁组(R4组,n=46),比较各组术后效果。结果全组手术均顺利完成,无严重并发症。各组手术时间、输血量、术后24 h胸腔引流量差异均无统计学意义(P>0.05)。在体外循环(CPB)时间、主动脉阻断时间、术后心胸外科ICU滞留时间方面,R1、R2组较R3、R4组时间长,差异均有统计学意义(P<0.05)。R1组术后呼吸机支持时间、术后住院时间较R3、R4组长,输血量较多(P<0.05)。R4组较R1、R3组术后并发症发生率高(P<0.05)。结论RVIAT下VSD修补术应用于>2岁患儿可能较应用于4个月至2岁患儿疗效更好,2~5岁可能为RVIAT下VSD修补术疗效最佳的年龄段。

Objective To study the safety of right vertical infra-axillary thoracotomy(RVIAT)in the repair of ventricular septal defect(VSD)and the optimal age for RVIAT.Methods Between June 2014 and June 2018,441 children underwent VSD repair via RVIAT in our hospital.According to the age,they were divided into four groups:a 4 months to 1 year old group(R1 group,n=123),a 1-2 years old group(R2 group,n=106),a 2-5 years old group(R3 group,n=166),a>5 years old group(R4 group,n=46).The clinical effects of the patients were compared.Results All the operations were successfully performed and no serious complication was found in all groups.No statistical difference was observed in the operation time,blood loss during operation,thoracic drainage 24 h after operation among groups(P>0.05).The cardiopulmonary bypass time,aortic cross-blocking time and ICU stay time in the R1 and R2 groups were longer than those in the R3 and R4 groups(P<0.05).In the R1 group,the postoperative ventilating time and postoperative hospital stay time were longer,and the blood transfusion volume was more than those in the R3 and R4 groups(P<0.05).The incidence of postoperative complications was higher in the R4 group than that in the R1 and R3 groups(P<0.05).Conclusion VSD repair via RVIAT may be more effective in children>2 years old,and 2-5 years old may be the optimal age.