三种入径治疗先天性心脏病的比较

目的分析比较正中切口、右腋下直切口、胸腔镜三种不同人径治疗先天性心脏病的效果。方法随机选择正中切口组20例，其中房间隔缺损（ASD）3例，室间隔缺损（VSD）7例，VSD合并PFO8例（合并ASD2例）；右腋下直切口组14例，其中ASD6例（合并三尖瓣关闭不全1例），VSD3例，VSD合并PFO4例；胸腔镜组17例，其中ASD6例，VSD9例，VSD合并PFO2例。比较三组患者的手术时间、体外循环时间、主动脉阻断时间、引流量、呼吸机辅助时间、ICU时间、术后住院天数、总费用等指标，分析其疗效。结果三组手术时间、体外循环时间、主动脉阻断时间差异均无统计学意义（P〉0．05）；引流量正中切口组为（185．0±44.3）ml，明显高于腋下直切口组的（94．6±75．3）ml（P〈O．05）；呼吸机辅助时间正中切口组为（10．9±8．3）h，明显高于腔镜组的f4．2±2-3）h（P〈0．05）；正中切口组的ICU时间为（39．8±10．7）h，术后住院天数为（7．6±1.3）d，总费用（27943±2352）元，均明显高于腋下直切口组的（26．9±9．1）h，（6．5±1．2）d，（25786±1130）元（P〈O．05）和腔镜组的（20．0±2．2）h，（6．1±1．1）d，（25225±2900）元（P〈O．05）。结论右腋下直切口和胸腔镜治疗先天性心脏病具有创伤小、瘢痕隐蔽、术中及术后出血少、术后恢复快、住院天数短和费用低等优点，值得推广。

Comparison of three different approaches for therapying of congenital heart disease

Objective Comparasion of management of congenital heart disease via median sternotomy in- cision（MSI）, right axillary minithoraeotomy（RAM） and thoracoscopy（TS）. Methods 51 patients were selected into three groups randomly. 20 patients underwent median sternotomy incision （Atrial Septal defect（n=3） including ven- tricular septal defect （n=7）, ventrieular septal defect with patent foramen ovale （n=8）, ventricular septal defect with Atrial Septal defect（n=2）. 14 patients underwent right axillary minithoracotomy including atrial septal defect（n=5）, atrial septal defect with tricuspid insufficiency （n=l）, ventricular septal defect （n=3）, ventricular septal defect with patent foramen ovale（n=4）. 17 patients underwent thoraeoscopy including atrial septal defect（n=6）, ventricular septal defect （n=9）, ventrieular septal defect with patent foramen ovale （n=2）. The operation time, cardiopulmonary bypass time, aortic cross-clamping time, drainage, mechanical ventilation time, ICU stay, postoperative hospital stay, the total cost were compared among three groups. Results There was no significant difference in operation time, car- diopulmonary bypass time, aortic cross-clamping time（P〉0.05）. Drainage in MSI group were （185.0±44.3）ml, high- er than in RAM group（94.6＋75.3 ）ml（P〈0.05 ）. Mechanical ventilation time in MSI group were （10.9±8.3）h, sig- nificantly higher than in TS group （4.2＋2.3）h（P〈0.05 ）. ICU stay in MSI group were （39.8±10.7）h,postoperative hospital stay were （7.6±l.3）d,the total cost were （27943±2352）RMB, significantly higher than in RAM group （26.9±9.1）h, （6.5±1.2）d,25786±l130）RMB（P〈0.05）and TS gronp（20±2.2）h, （6.1±1.1）d, （25225±2900）RMB （P〈0.05）. Conclusion Right axillary minithoraeotomy and thoracoscopy approaches have the advantage of a mini incision, least drainage, rapid recovery, shorten hospital stay and cost advantages, worthy of promotion.