右腋下切口经胸封堵术与传统外科手术治疗室间隔缺损临床疗效的回顾性队列研究

Clinical efficacy of transthoracic occlusion via a right subaxillary incision and conventional surgery in the treatment of ventricular septal defect: A retrospective cohort study

目的对比分析右腋下切口经胸封堵术与传统外科手术治疗室间隔缺损(VSD)的临床疗效。方法回顾性分析2017年1月至2020年1月在我院接受经右腋下切口径路行先天性VSD手术治疗患者临床资料,根据手术方法将患者分为两组:传统外科手术组(传统组)与经胸封堵组(封堵组)。传统组患者221例,其中男97例、女124例,平均年龄(2.6±2.2)岁,平均体重(13.4±6.2)kg;封堵组患者185例,其中男90例、女95例,平均年龄(3.2±2.6)岁,平均体重(14.7±6.6)kg。比较两组临床效果。结果两组患者手术成功率均为100%;封堵组术中失血量少于传统组(P<0.05);切口长度、手术时间、术后机械辅助通气时间、重症监护室滞留时间、术后恢复正常饮食时间、术后恢复正常活动时间也均短于传统组(P均<0.05);住院期间总费用传统组低于封堵组(P<0.001);围手术期两组并发症发生率差异无统计学意义(P>0.05);随访时间(15.8±8.8)个月,随访过程中,传统组并发症发生率高于封堵组,差异有统计学意义(P<0.001)。结论右腋下切口经胸封堵术与传统外科手术相比,具有切口小、手术时间短、失血量少、术后恢复时间短等优势,且远期并发症少,但住院总费用偏高,主要为耗材费用偏高,远期效果仍需进一步对比观察。

Objective To analyze the clinical efficacy of transthoracic occlusion via a right subaxillary incision and conventional surgery in the treatment of ventricular septal defect(VSD). Methods The clinical data of patients with congenital VSD undergoing right subaxillary incision surgery in our hospital from January 2017 to January 2020 were retrospectively analyzed. According to the surgical methods, the patients were divided into two groups: a conventional surgery group(conventional group) and a transthoracic occlusion group(occlusion group). There were 221 patients in the conventional group, including 97 males and 124 females, with an average age of 2.6±2.2 years and an average weight of 13.4±6.2 kg;there were 185 patients in the occlusion group, including 90 males and 95 females, with an average age of 3.2±2.6 years and an average weight of 14.7±6.6 kg. The clinical effectiveness was compared. Results The success rate of surgery was 100% in both groups. The intraoperative blood loss was less in the occlusion group(P<0.05). The incision length, operation time, postoperative mechanical ventilation time, retention time in the intensive care unit, the time to resume normal diet and normal activities after operation were all shorter than those in the conventional group(P all<0.05). The total cost during hospitalization of the conventional group was less than that of the occlusion group(P<0.001).There was no statistical difference in the incidence rate of perioperative complications between the two groups(P>0.05).During the follow-up(15.8±8.8 months), the incidence of complications in the conventional group was higher than that in the occlusion group with a statistical difference(P<0.001). Conclusion Compared with conventional surgery,transthoracic occlusion for VSD via right subaxillary incision has the advantages of smaller incision, shorter operation time, less blood loss, shorter postoperative recovery time and less long-term complications. However, the total hospitalization cost is relatively high, mainly because of the high consumables cost, and the long-term effects still need further comparative observation.