CAJ | 학술논문

目的比较采用完全胸腔镜下和常规正中胸骨开胸直视下进行房间隔缺损修补术的临床效果,为临床选择房间隔缺损修补手术的术式提供参考.方法 2012年1月至2013年3月,100例房间隔缺损患者,男37例,女63例.按照手术方式分为两组:胸腔镜组50例,男20例,女30例,年龄(22.6±8.2)岁,体质量(49.6±17.2) kg;开胸组50例,男17例,女33例,年龄(23.3±7.5)岁,体质量(47.5 ±16.5) kg.两组患者分别行完全胸腔镜下房间隔缺损修补术或常规正中胸骨开胸直视房间隔缺损修补术,记录临床手术和治疗数据结果.结果两组患者术后无死亡,无严重并发症.开胸组与胸腔镜组相比,手术时间[(121.3 ±20.5)min对(105.3±17.5) min,P＜0.05]、ICU气管插管[(210.0±36.5)min对(100.0±47.5) min,P ＜0.05]、术后胸腔引流量[(350.3±50.8)ml对(47.0±10.9) ml,P ＜0.005]、术后住院时间[(6.2±1.7)天对(4.4±1.5)天,P＜0.005]和术后3周恢复工作者比例(0对78.4％,P＜0.005),组间差异均有统计学意义.术后3个月随访两组均无残余分流等异常.结论完全胸腔镜下房间隔修补术的手术创伤小,疗效满意,社会及经济效益良好.在严格筛选患者和把握手术适应证、术者胸腔镜及心内手术操作技能熟练的情况下,完全胸腔镜下房间隔缺损修补术可作为外科治疗先天性房间隔缺损优先选择的方法.
목적 비교채용완전흉강경하화상규정중흉골개흉직시하진행방간격결손수보술적림상효과,위림상선택방간격결손수보수술적술식제공삼고.방법 2012년1월지2013년3월,100례방간격결손환자,남37례,녀63례.안조수술방식분위량조:흉강경조50례,남20례,녀30례,년령(22.6±8.2)세,체질량(49.6±17.2) kg;개흉조50례,남17례,녀33례,년령(23.3±7.5)세,체질량(47.5 ±16.5) kg.량조환자분별행완전흉강경하방간격결손수보술혹상규정중흉골개흉직시방간격결손수보술,기록림상수술화치료수거결과.결과 량조환자술후무사망,무엄중병발증.개흉조여흉강경조상비,수술시간[(121.3 ±20.5)min대(105.3±17.5) min,P＜0.05]、ICU기관삽관[(210.0±36.5)min대(100.0±47.5) min,P ＜0.05]、술후흉강인류량[(350.3±50.8)ml대(47.0±10.9) ml,P ＜0.005]、술후주원시간[(6.2±1.7)천대(4.4±1.5)천,P＜0.005]화술후3주회복공작자비례(0대78.4％,P＜0.005),조간차이균유통계학의의.술후3개월수방량조균무잔여분류등이상.결론 완전흉강경하방간격수보술적수술창상소,료효만의,사회급경제효익량호.재엄격사선환자화파악수술괄응증、술자흉강경급심내수술조작기능숙련적정황하,완전흉강경하방간격결손수보술가작위외과치료선천성방간격결손우선선택적방법.
Objective To examine whether the minimally invasive video-assisted thoracoscopic surgery(VATS) in atrial septal defect(ASD) closure yields better clinical outcome equivalent to those of more established procedures,such as median sternotomy,moreover,to provide our own clinical experience in ASD Closure.Methods From January 2012 to January 2013,100 ASD patients were treated,50 patients received traditional open heart surgery (OHS group),17 males and 33 females,aged(23.3 ± 7.5) years,weighted (47.5 ± 16.5) kg; 50 patients underwent video-assisted thoracoscopic surgery (VATS group),20 males and 30 females,(22.6 ± 8.2) years old and (49.6 ± 17.2) kg weight.Collected and analyzed the clinical date of intraoperation and postoperation.Results All patients survived after surgery without serious complications like death.Clinical date of both group(OHS group vs.VATS group)include:Total operating room time (121.3 ± 20.5) min vs.(105.3±17.5) min (P＜0.05); tracheal intubation time in ICU (210.0±36.5) min vs.(100.0 ±47.5) min(P＜0.05) ; volume of thoracic drainage after operation (350.3 ± 50.8) ml vs.(47.0 ± 10.9) ml (P ＜ 0.005) ; postoperative length of hospital stay (6.2 ± 1.7) days vs.(4.4 ± 1.5) days (P ＜ 0.005).Rate of return to work in 3 weeks of postoperation 0 vs.78.4％ (P ＜ 0.005).Conclusion Completed VATS in ASD closure is less invasive,accelerates recovery and maintains overall surgical efficacy,which brings good economic and social benefits.For the appropriate patients,and for the experienced and skilled surgeon,completed VATS is the best method of choice of ASD closure in our department.