“二孔法”胸腔镜技术在先天性心脏病外科的临床应用研究

Clinical application of"two-port"thoracoscopic technique in congenital heart disease surgery

目的探讨“二孔法”胸腔镜技术在先天性心脏病患者外科手术中的应用价值。方法60例先天性心脏病患者,随机分成实验组和对照组,每组30例。对照组采取传统开胸手术治疗,实验组采取“二孔法”胸腔镜技术治疗。比较两组患者的手术指标,包括体外循环时间、手术时间、24 h引流量、呼吸机使用时间、重症加强护理病房(ICU)监护治疗时间、住院时间、术后3 d疼痛评分。观察并发症及随访情况。结果两组患者的体外循环时间、手术时间比较,差异无统计学意义(P>0.05);实验组患者的24 h引流量(89.5±29.75)ml少于对照组的(215.00±103.00)ml,呼吸机使用时间(214.00±37.50)min、ICU监护治疗时间(17.00±5.00)h、住院时间(9.00±1.00)d短于对照组的(377.50±46.25)min、(29.00±4.00)h、(15.00±4.25)d,术后3 d疼痛评分(3.50±1.00)分低于对照组的(7.00±2.25)分,差异有统计学意义(P<0.05)。全部患者无残余漏、脑梗死、低心排出量综合征、心律失常,无死亡患者。所有患者出院后均随访1年,均无明显并发症。结论“二孔法”胸腔镜技术用于先天性心脏病外科手术中,手术创伤小,恢复快,并发症少,安全可行。

Objective To discus the practical value of"two-port"thoracoscopic technique in congenital heart disease surgery.Methods A total of 60 patients with congenital heart disease were randomly divided into experimental group and control group,with 30 cases in each group.The control group was treated with traditional thoracotomy,and the experimental group was treated with"two-port"thoracoscopic surgery.The surgical indicators of the two groups were compared,including extracorporeal circulation time,operation time,24-h drainage volume,time on ventilator,intensive care unit(ICU)monitoring and treatment time,hospitalization time,and pain score at 3 d postoperatively.The complications and follow-up were observed.Results There was no statistically significant difference in the extracorporeal circulation time and operation time between the two groups(P>0.05).In the experimental group,the 24-h drainage volume(89.5±29.75)ml was less than(215.00±103.00)ml in the control group,and time on ventilator(214.00±37.50)min,ICU monitoring and treatment time(17.00±5.00)h,and hospitalization time(9.00±1.00)d were shorter than(377.50±46.25)min,(29.00±4.00)hand(15.00±4.25)d in the control group,and pain score at 3 d postoperatively(3.50±1.00)points was lower than(7.00±2.25)points in the control group.All the differences were statistically significant(P<0.05).All patients were free of residual leakage,cerebral infarction,low cardiac output syndrome,arrhythmias,and no patients died.All patients were followed up for 1 year after discharge and had no significant complications.Conclusion The"two-port"thoracoscopic technique for the correction of congenital heart disease is safe and feasible with less trauma,faster recovery and fewer complications.