胸骨下段小切口及胸骨正中切口治疗儿童先天性心脏病的对比研究

回顾性分析采用胸骨下段小切口及胸骨正中切口治疗儿童简单先天性心脏病198例的临床资料，并分为胸骨下段小切口组（小切口组）和胸骨正中切口组（正中切口组），病种包括室间隔缺损（VSD）与房间隔缺损（ASD）。两组患者的年龄、性别、体重、左室射血分数和心胸比率差异均无统计学意义，均无死亡病例。ASD 修补术中小切口组的手术时间、术后呼吸机辅助呼吸时间、术后24 h 引流量及切口长度均小于正中切口组，差异有统计学意义（ P <0.05），体外循环时间及术后住院天数的差异无统计学意义；VSD 修补术中小切口组的手术时间、术后24 h 引流量、切口长度均小于正中切口组，差异有统计学意义（P <0.05），而体外循环时间、术后呼吸机辅助呼吸时间及术后住院时间与正中切口组的差异无统计学意义。两组随访2个月~3年，患者心功能均为Ⅰ级。小切口组无胸骨畸形，正中切口组6例出现鸡胸。胸骨下段小切口行儿童简单先天性心脏病修补手术安全可行，较传统切口更美观、微创。

Comparison of the treatment of pediatric congenital heart disease via lower partial median sternotomy and median sternotomy

Retrospective analyses of the clinical results of 198 children performed congenital heart disease repair via lower partial median sternotomy and median sternotomy approaches. All patients were divided into lower partial median sternotomy group(group A)and midian sternotomy group(group B). Age,gender,body weight,left ven-tricular ejection fraction and cardiothoracic ratio were similar between the two groups. There was no death case in the two groups. In ASD repair operation time,mechanical ventilation time,chest drainage within 24 h after opera-tion and length of incision were significantly lower in the group A than in group B(P < 0. 05). Cardiopulmonary by-pass time and postoperative hospital stay time were similar between the two groups. In VSD repair operation time, chest drainage within 24 h after operation and length of incision were significantly lower in the group A than in group B( P < 0. 05). Cardiopulmonary bypass time,mechanical ventilation time and postoperative hospital stay time were similar between the two groups. All patients had NYHA class I heart function during 2 ~ 36 months fol-low-up. There was no sternal malformation in group A,and 6 cases of chicken breast in group B. Pediatric congen-ital open heart operation via lower partial median sternotomy is not only effective and safe,but also has cosmetic and minimally invasive results.