经胸微创封堵与体外循环治疗不同直径干下型VSD疗效分析

目的 探讨干下型室间隔缺损(VSD)直径大小对手术疗效的影响,对比分析经胸微创封堵与体外循环治疗不同直径干下型室间隔缺损的治疗效果.方法 对2008年8月至2016年8月中南大学湘雅医学院附属海口医院心胸外一科收治的63例缺损直径在3～10 mm的先天性干下型VSD 2～6岁患儿病例资料进行回顾性分析,其中男性35例,女性28例.依据手术方式的不同将其分为体外组和微创组,再依据直径大小差异各分为两组,经胸微创封堵治疗34例,男女比例为19/15,其中直径3～5 mm 13例,>5 mm 21例;正中切口体外循环治疗29例,男女比例为16/13,其中直径在3～5 mm 11例,>5 mm 18例.分别对其手术成功率、术中术后情况及术后并发症进行比较,进行统计分析.结果 体外组手术时间、输血总量、机械通气时间、术后重症监护时间、术后住院时间均较微创组长,两种手术方式总体成功率差异有统计学意义(P<0.05).缺损直径在3～5 mm时,两种手术方式治疗干下型室间隔缺损的手术成功率均为100.00％,差异无统计学意义(P>0.05);缺损直径在5～10 mm时,体外组手术成功率为100.00％,明显高于微创组的80.95％,差异有统计学意义(P=0.045).手术失败患者的缺损直径均在8～10 mm.两种手术治疗方式的手术时间、输血总量、机械通气时间、术后重症监护时间、术后住院时间及手术成功率均不受缺损直径大小的影响(P>0.05).两种手术治疗干下型室间隔缺损的术后早期并发症比较差异均无统计学意义(P>0.05),但两种手术方式治疗干下型室间隔缺损的总早期并发症发生率差异有统计学意义(P=0.041),体外组的总体发生率为5.75％,高于微创组的1.67％.两种手术治疗方式的早期并发症发生率不受缺损直径大小的影响(P>0.05).结论 VSD缺损直径大小对不同手术治疗方式的成功率有影响.体外组早期并发症发生率较微创组高,早期并发症发生率不受缺损直径大小影响;微创组较体外组术中优势明显.缺损直径较小选择微创封堵优势明显,缺损直径越大选择体外循环手术治疗优势越明显.

Curative effect of transthoracic mini-invasive occlusion and cardiopulmonary bypass on subpulmonic ventricular septal defect of different diameters

Objective To investigate the effect of diameter of subpulmonic ventricular septal defect (VSD) on the curative effect of operation, and to compare the curative effect of transthoracic mini-invasive occlusion and cardiopul-monary bypass on subpulmonic VSD of different diameters. Methods The clinical data of 64 children with the diame-ter of 3-10 mm congenital subpulmonic VSD, including 35 males and 28 females, who admitted to Cardiothoracic De-partment of Central South University Xiangya School of Medicine Affiliated Haikou Hospital from August 2008 to Au-gust 2016, were retrospectively analyzed. The patients were divided into in vitro and mini-invasive group according to the different surgical methods, and then were divided into two groups according to their differences in diameter. There were 34 cases in the mini-invasive group with male to female ratio of 19/15, with 13 cases of 3-5 mm diameter and 21 cases of more than 5 mm. There were 29 cases of median incision cardiopulmonary bypass (in vitro group) with male to female ratio of 16/13, with 11 cases of 3-5 mm diameter, 18 cases of more than 5 mm. The operative success rate, intra-operative and postoperative complications were compared and analyzed statistically. Results The operative time, total blood transfusion, mechanical ventilation time, postoperative intensive care time and postoperative hospitalization time of in vitro group were significantly longer than those of mini-invasive group (P<0.05). There was a significant difference in the overall success rate between the two surgical methods (P<0.05). There was no significant difference in the success rate between the two groups in the 3-5 mm diameter of the defect (100.00％vs 100.00％, P>0.05). When the diameter of the defect was 5-10 mm, the success rate of in vitro group was 100.00％, which was significantly higher than 80.95％of the mini-invasive group (χ2=4.021, P=0.045). All failed patients had a defective diameter of 8 mm to 10 mm. The opera-tive time, total blood transfusion, mechanical ventilation time, postoperative intensive care time, postoperative hospital stay and operation success rate were not affected by the diameter of the defect (P>0.05). There was no significant differ-ence in the early complications of the two types of surgical treatment of subpulmonic VSD (P>0.05). However, there were statistically significant differences in the incidence of early complications between the two surgical methods for the treatment of subpulmonic VSD (P=0.041). The overall incidence of the in vitro group was 5.75％, which was signifi-cantly higher than 1.67％of mini-invasive group. The incidence of early complications of both surgical treatments was not affected by diameter (P>0.05). Conclusion The diameter of VSD has an effect on the success rate of different surgical methods. The incidence of early complications in the cardiopulmonary bypass (in vitro) group was higher than that in the mini-invasive group, and the incidence of early complication was not affected by the diameter of the defect. The minimally invasive group has obvious advantages than the cardiopulmonary bypass group. For the defect with the smaller diameter, the mini-invasive occlusion has obvious advantages. Otherwise, cardiopulmonary bypass has obvious advantages.