体外循环下经右腋下小切口治疗小儿室间隔缺损

Treatment of ventricular septal defect in children through right subaxillary small incision under extracorporeal circulation

目的通过分析对比正中切口与右侧腋下小切口行室间隔缺损修补术的病例资料,探讨体外循环下经右腋下小切口行室间隔缺损修补术的可行性。方法回顾性分析2009年1月至2015年12月,我院体外循环下行室间隔缺损修补术80例病例资料。根据手术切口方式不同分为两组,经右腋下小切口组(观察组,n=40)和正中切口组(对照组,n=40),对两组病历资料数据进行分析,指标包括:手术时间、体外循环时间、升主动脉阻断时间、平均灌注流量、平均灌注压、平均泵压、术中出血量、术后24h引流量、术后输血例数、呼吸机使用时间、ICU时间、术后住院天数等。结果两组患儿手术均顺利成功,两组术前资料,性别、月龄、体重、室缺缺损大小及合并症无明显统计学差异(P>0.05)。术中及术后指标中手术时间、体外循环时间、升主动脉阻断时间、转中平均灌注流量、平均灌注压及术后呼吸机使用时间两组无明显统计学差异(P>0.05);观察组在术中出血量、术后24h引流量、术后输血例数、ICU时间、术后住院天数及刀口长度方面明显低于对照组,差异有统计学意义(P<0.05)。结论体外循环下经右腋下小切口入路行室间隔缺损修补技术安全可行,创伤更小,机体恢复更快。

Objective To explore the feasibility of ventricular septal defect repair by cardiopulmonary bypass through right subaxillary small incision by analyzing and comparing the case data of median incision and right subaxillary small incision.Methods Retrospective analysis was conducted from January 2009 to January 2009 During December 2015,data of 80 cases of ventricular septal defect repair under extracorporeal circulation in our hospital were divided into two groups according to different surgical incision methods:the right axillary small incision group(observation group,n=40)and the median incision group(control group,n=40).The medical data of the two groups were analyzed,and the indexes included:operation time extracorporeal circulation time Ascending aorta blocking time Average perfusion flow average perfusion pressure average pump pressure intraoperative blood loss 24h postoperative drainage flow postoperative blood transfusion rate Ventilator use time ICU time postoperative hospital stay.Results Surgery was successful in both groups,preoperative data of both groups,gender,age,weight There were no statistically significant differences in the size and complications of ventricular defects(P>0.05)There were no significant differences in intraoperative and postoperative indicators between the two groups in operative time,cardiopulmonary bypass time,ascending aorta blocking time,mean perfusion flow,mean perfusion pressure and postoperative ventilator use time(P>0.05);The observation group was significantly lower than the control group in terms of intraoperative blood loss,24h postoperative drainage flow,postoperative blood transfusion rate,ICU time,postoperative hospital stay and incision length(P<0.05),and the difference was statistically significant.Conclusion The repair technique of ventricular septal defect through right subaxillary small incision under CPB is safe and feasible,with less trauma and faster body recovery.