完全胸腔镜技术在部分型房室间隔缺损心内矫治术中的应用及优势

目的回顾分析全胸腔镜与正中开胸行部分型房室间隔缺损(partial atrioventricular septal defect，PAVSD)矫治术的临床病例资料，探讨全胸腔镜下在PAVSD心内矫治术中的应用及优势。 方法回顾研究2010年1月至2017年12月于空军军医大学第一附属医院实施PAVSD的226例患者的临床资料，分为完全胸腔镜组及正中开胸组。分析两组患者的手术创伤指标、术后恢复相关临床指标及其远期随访情况进行比较。 结果226例患者均成功接受手术，完全胸腔镜组在输血量(90.6±52.3)ml比(285±103.5)ml]、术中出血量(109.2±25.4)ml比(235.3±101.3)ml]、引流量(115.1±63.2)ml比(225.2±97.3)ml]上均少于正中开胸组，差异有统计学意义(P<0.05)；在关胸时间(12.0±3.6)min比(44.2±15.0)min]、手术时间(155.3±28.7)min比(183.6±37.6)min]、疼痛评分(3.4±0.7)分比(6.9±1.5)分]、术后住院时间(6.2±2.1)d比(10.7±2.9)d]及ICU监护时间(42.1±11.9)h比(60.3±12.4)h]方面，较正中开胸组缩短，差异有统计学意义(P<0.05)；两组主动脉阻断时间差异无统计学意义；完全胸腔镜组术后出现切口愈合不良并发症的概率(0.9%比5.6%)明显低于正中开胸组(P<0.05)；完全胸腔镜组术后出现肺不张、气胸的概率略高于正中开胸组，出现脑、肝、肾并发症概率与正中开胸组相仿，差异无统计学意义；完全胸腔镜组术后出现心包压塞、高度房室传导阻滞概率低于正中开胸组，差异无统计学意义；两组患者术后1年心脏左心室射血分数值差异无统计学意义。 结论完全胸腔镜手术行PAVSD心内矫治术手术疗效确实可靠，手术创伤小，术后并发症少，切口隐蔽美观，术后恢复快，是一种安全、有效、微创的手术方式，值得大范围的推广。

Application and advantages of complete thoracoscopy in the intracardiac correction of partial atrioventricular septal defect

ObjectivesThe clinical data of partial atrioventricular septal defect (PAVSD) treated by total thoracoscopy and median thoracotomy were retrospectively analyzed. The application and advantages of total thoracoscopy in PAVSD were discussed. MethodsA retrospective study was conducted on 226 patients with partial atrioventricular septal defect from Jan. 2010 to Dec. 2017 in the First Affiliated Hospital of Air Force Military Medical University. They were divided into complete thoracoscopy group and median thoracotomy group. The indexes of surgical trauma, clinical indexes of postoperative recovery and long-term follow-up were collected and compared between the two groups. Result226 cases were operated successfully.The complete thoracoscopy group was less than the median thoracotomy group in terms of blood transfusion(90.6±52.3)ml vs (285±103.5)ml]、intraoperative bleeding (109.2±25.4)ml vs (235.3±101.3)ml] and postoperative drainage (115.1±63.2)ml vs (225.2±97.3)ml], and the difference was statistically significant(P<0.05). The time of closing the chest(12.0±3.6)min vs (44.2±15.0)min], operation time (155.3±28.7)min vs (183.6±37.6)min], pain score(3.4±0.7)vs(6.9±1.5)], postoperative hospital stay(6.2±2.1)d vs (10.7±2.9)d] and ICU recovery time(42.1±11.9)h vs (60.3±12.4)h] were shorter than those of the median thoracotomy group, and the difference was statistically significant.There was no significant difference in the time of aortic occlusion between the two groups (P<0.05). The incidence of complications of poor wound healing in the complete thoracoscopy group was significantly lower than that in the median thoracotomy group (P<0.05). The incidence of atelectasis and pneumothorax in the complete thoracoscopy group was slightly higher than that in the median thoracotomy group, the difference was not statistically significant.The incidence of pericardial tamponade and high atrioventricular block in the complete thoracoscopy group was lower than that in the median thoracotomy group.One year after operation, there was no significant difference in EF value between the two groups. ConclusionsComplete thoracoscopic surgery for PAVSD is a safe, effective and minimally invasive method with less trauma, fewer complications, beautiful incision and short recovery period. It is worth popularizing widely.