微创小切口心脏手术与常规切口的对比研究

目的 探讨心脏手术不同入路的创伤、疗效和预后,以指导临床.方法 对41例动脉导管未闭患者行左腋下小切口(A组);46例房间隔缺损、室间隔缺损、法洛三联症患者行右腋下小切口(C组);49例瓣膜置换、室间隔缺损、房间隔缺损、法洛四联症、左心房黏液瘤患者行胸骨下段小切口(D组);与常规左胸后外侧切口42例(B组)及胸骨正中切口77例(E组)进行对比观察.结果 (1)A组手术时间(38±13)min、出血量(17±12)ml、住院天数(6±2)d,与B组分别为(64±14)min、(200±100)ml、(11±3)d]比较差异均有统计学意义(P<0.01).(2)C组体外循环时间(39±8)min、出血量(150±150)ml、住院天数(8±3)d,与E组分别为(68±8)min、(700±300)ml、(12±4)d]比较差异均有统计学意义(P<0.01或<0.05).D组出血量、引流量与E组比较差异有统计学意义(P<0.05).结论 左腋下小切口、右腋下小切口、胸骨下段小切口手术具有切口小、出血少、创伤小、疼痛轻、胸廓稳定、恢复快、住院天数少、切口隐蔽等优点.

A study of comparison between small incision of cardiac operation and regular incision

Objective To guide clinical operation,the invasion,efficacy,convalescence by different operating ways on cardiac surgery were studied.Methods Left axillary minithoracotomy was applied to 41 patients with ductus atteriosus(A group);right axillary minithoracotomy was applied to 46 patients with atrial soptal defect (ASD),ventricular septal dofect(VSD),triple-symptom complex of Fallot(C group);49 patients with replacement of valvular heart,VSD,ASD,totralogy of Fallot,left atrial myxoma were operated in substernal segment minithoracotomy (D group).The comparison between above groups and the regular left chest posterolateral operation on 42 patients (B group) and the sternal median operation on 77 patients (E group)was carried out.Results (1) A group had such advantages as the operation time,hemorrhage volume,hospital day,compared with B group (38±13) min vs (64±14) min,(17±12) ml vs (200±100) ml,(6±2) d vs(11±3) d,respectively](P<0.01).(2) There were difference in extra corporeal circulation time,bemorrhage volume and hospital day between C group and E group(39±8) min vs (68±8)min,(150±150) ml vs (700±300)ml,(8±3)d vs(12±4)d,respectively](P<0.01 or <0.05).There were difference in hemorrhage volume,fluence between D group and E group (P<0.05).Conclusion Small incision,slight trauma,less hemorrhage,slight ache,quick recovery,concealed incision and so on are characteristic of the left subaxillary minithoracotomy for ligation of ductus arteriosus,the right subexillary minithoracotomy for opening heart operation with heart beating and the substernal segment minithoracotomy for opening heart operation with extra corporeal circulation.