胸骨旁入路小切口手术治疗房间隔缺损的临床疗效分析

Clinical efficacy of parasternal approach small incision surgery for treatment of atrial septal defect

目的探讨胸骨旁入路小切口手术治疗房间隔缺损的临床疗效。方法88例房间隔缺损患者,随机分为观察组和对照组,每组44例。对照组行标准胸骨正中切口手术,观察组行胸骨旁入路小切口手术。比较两组患者手术指标、并发症发生率、术后3个月心功能指标。结果观察组手术时间(121.34±16.15)min、体外循环时间(56.12±10.54)min、主动脉阻断时间(41.50±6.96)min、机械通气时间(4.57±1.05)h、ICU停留时间(14.23±2.28)h、术后住院时间(7.11±1.23)d均短于对照组的(143.67±15.54)min、(60.72±11.03)min、(49.28±7.04)min、(6.79±1.18)h、(21.35±4.06)h、(9.49±2.01)d,切口长度(5.45±0.78)cm短于对照组的(13.21±1.69)cm,术中出血量(120.42±27.37)ml、术后24 h引流量(214.31±32.16)ml均少于对照组的(372.64±78.95)、(345.68±33.26)ml,差异均具有统计学意义(P<0.05)。观察组并发症发生率6.82%低于对照组的25.00%,差异具有统计学意义(P<0.05)。观察组术后3个月的右心室射血分数、舒张末期右心室容积、收缩末期右心室容积与对照组比较,差异均无统计学意义(P>0.05)。结论胸骨旁入路小切口手术治疗房间隔缺损的临床疗效显著,创伤小,术后恢复快,并发症发生率低,能有效改善心功能,具有积极的临床意义。

Objective To investigate the clinical efficacy of parasternal approach small incision surgery for treatment of atrial septal defect.Methods A total of 88 patients with atrial septal defect were randomly divided into observation group and control group,with 44 cases in each group.The control group was treated with standard median sternotomy,and the observation group was treated with parasternal approach small incision surgery.The surgical indicators,occurrence of complications,and cardiac function indicators at 3 months after operation were compared between the two groups.Results The operation time(121.34±16.15)min,cardiopulmonary bypass time(56.12±10.54)min,aortic occlusion time(41.50±6.96)min,mechanical ventilation time(4.57±1.05)h,ICU stay time(14.23±2.28)h and postoperative hospitalization time(7.11±1.23)d of the observation group were shorter than(143.67±15.54)min,(60.72±11.03)min,(49.28±7.04)min,(6.79±1.18)h,(21.35±4.06)h and(9.49±2.01)d,incision length(5.45±0.78)cm was shorter than(13.21±1.69)cm of the control group,and intraoperative blood loss(120.42±27.37)ml and 24 h postoperative drainage volume(214.31±32.16)ml were less than(372.64±78.95)and(345.68±33.26)ml of the control group.All the difference was statistically significant(P<0.05).The incidence of complications 6.82%of the observation group was lower than 25.00%of the control group,and the difference was statistically significant(P<0.05).3 months after operation,there was no statistically significant difference in right ventricular ejection fraction,end-diastolic right ventricular volume,end-systolic right ventricular volume between the observation group and control group(P>0.05).Conclusion Parasternal approach small incision surgery shows remarkable clinical efficacy on atrial septal defect,with less trauma,faster postoperative recovery,and low incidence of complications,and it can effectively improve the cardiac functions.It contains positive clinical significance.