胸腔镜与开胸手术治疗先天性心脏病的对照研究(1)
摘 要 目的：观察研究胸腔镜与传统开胸手术治疗先天性心脏病的临床治疗效果。方法：选取我院收治的先天性心脏病患者56例，根据监护人或患者意愿分为腔镜组26例和传统组30例，腔镜组施行完全胸腔镜下手术，传统组采用常规直视下开胸手术。观察比较两组患者的升主动脉阻断时间、体外循环时间、术后呼吸机辅助呼吸时间、术后住院时间、手术时间、胸腔引流量和术后并发症等。结果：腔镜组胸腔引流量和术后住院时间明显优于开胸组(P<0.05)，而两组其它各方面的比较无统计学意义(P>0.05)；经随访两组患者心功能均I级。结论：全胸腔镜下治疗先天性心脏病，可减少创伤、缩短住院时间、并具有显著美容效果等优点，值得临床推广应用。
关键词 胸腔镜 开胸手术 先天性心脏病 体外循环
中图分类号：R654.2 文献标识码：B 文章编号：1006-1533(2014)19-0035-03
Comparative study on the thoracoscopic and open chest surgeries
, 百拇医药
for the treatment of congenital heart disease*
FANG Zheng**
(The First People’s Hospital of Jiujiang City， Jiujiang 332000， China)
ABSTRACT Objective： To analyze clinical therapeutic effect of both thoracoscopic surgery and the traditional open chest surgery in the treatment of congenital heart disease. Methods： Fifty-six patients with congenital heart disease hospitalized in our hospital were selected and divided into a laparoscopic group with 26 cases and a traditional group with 30 cases based on supervisor or patient wish. Patients underwent totally thoracoscopic surgery in the laparoscopic group while a conventional open chest surgery in the traditional group. The times for ascending aortic clamping， cardiopulmonary bypass (CPB)， postoperative mechanical ventilation， postoperative hospitalization and operation and the bleeding volume and postoperative complications were compared between two groups. Results： The volume of chest drainage and the time for postoperative hospital stay were significantly reduced in the laparoscopic group ( P<0.05) while the comparisons of other aspects had no significant difference between two groups ( P>0.05). The cardiac function of all patients could be confirmed as grade I after follow up. Conclusion： The treatment of congenital heart disease under thoracoscopy is worthy of clinical application because it can reduce the trauma， shorten the time of hospitalization and also has cosmetic advantage.
, 百拇医药
KEY WORDS thoracoscopy； open chest surgery； congenital heart disease； cardiopulmonary bypass
电视胸腔镜在心脏外科的治疗应用中已经有十余年历史，其手术种类最初为动脉导管钳闭术，后经不断的发展，现包括房间隔缺损修补、室间隔缺损修补、二尖瓣置换术、二尖瓣成形及冠状动脉搭桥术等多种手术形式[1]。由于其具有创伤小、术后疼痛轻、术后恢复时间短等优点成为胸外科当前的研究热点[2-3]。我院于2008年1月开始在上级医生指导下逐步开展电视胸腔镜下房间隔缺损、室间隔缺损修补术，至2012年12月已完成此类手术26例，无1例死亡。现对本组资料进行分析，并与传统手术组对照，以探讨电视胸腔镜下儿童先心手术的价值。
资料与方法
临床资料
选取2008年1月-2012年12月我院收治56例先天性心脏病患者，均根据体征，经心电图、心脏彩超、X线心脏平片等检查确诊断为先天性心脏病，年龄均>5岁，体重>18 kg，并无其他合并畸形的继发孔型房间隔缺损(atrial septal defect，ASD)和膜部室间隔缺损(ventricular septal defect，VSD)。其中VSD 24例，ASD 32例。根据监护人或患者意愿分为腔镜组26例和传统组30例。腔镜组中男16例，女10例；年龄6～19岁，平均(14.4±8.0)岁；体重(37.6±15.8)kg；心胸比例(0.51±0.03)；术前HB(119±11) g/L；NYHA心功能分级Ⅱ级24例，Ⅲ级2例；ASD 9例，VSD 17例。开胸组中男18例，女12例；年龄6～20岁，平均(15.2±7.9)岁；体重(38.2±15.3)kg；心胸比例(0.52±0.04)；术前HB(118±12)g/L；心功能分级Ⅱ级27例，Ⅲ级3例；ASD 13例，VSD 17例。两组患者一般情况比较无统计学意义(P>0.05)，具有可比性。, 百拇医药(方政)
关键词 胸腔镜 开胸手术 先天性心脏病 体外循环
中图分类号：R654.2 文献标识码：B 文章编号：1006-1533(2014)19-0035-03
Comparative study on the thoracoscopic and open chest surgeries
, 百拇医药
for the treatment of congenital heart disease*
FANG Zheng**
(The First People’s Hospital of Jiujiang City， Jiujiang 332000， China)
ABSTRACT Objective： To analyze clinical therapeutic effect of both thoracoscopic surgery and the traditional open chest surgery in the treatment of congenital heart disease. Methods： Fifty-six patients with congenital heart disease hospitalized in our hospital were selected and divided into a laparoscopic group with 26 cases and a traditional group with 30 cases based on supervisor or patient wish. Patients underwent totally thoracoscopic surgery in the laparoscopic group while a conventional open chest surgery in the traditional group. The times for ascending aortic clamping， cardiopulmonary bypass (CPB)， postoperative mechanical ventilation， postoperative hospitalization and operation and the bleeding volume and postoperative complications were compared between two groups. Results： The volume of chest drainage and the time for postoperative hospital stay were significantly reduced in the laparoscopic group ( P<0.05) while the comparisons of other aspects had no significant difference between two groups ( P>0.05). The cardiac function of all patients could be confirmed as grade I after follow up. Conclusion： The treatment of congenital heart disease under thoracoscopy is worthy of clinical application because it can reduce the trauma， shorten the time of hospitalization and also has cosmetic advantage.
, 百拇医药
KEY WORDS thoracoscopy； open chest surgery； congenital heart disease； cardiopulmonary bypass
电视胸腔镜在心脏外科的治疗应用中已经有十余年历史，其手术种类最初为动脉导管钳闭术，后经不断的发展，现包括房间隔缺损修补、室间隔缺损修补、二尖瓣置换术、二尖瓣成形及冠状动脉搭桥术等多种手术形式[1]。由于其具有创伤小、术后疼痛轻、术后恢复时间短等优点成为胸外科当前的研究热点[2-3]。我院于2008年1月开始在上级医生指导下逐步开展电视胸腔镜下房间隔缺损、室间隔缺损修补术，至2012年12月已完成此类手术26例，无1例死亡。现对本组资料进行分析，并与传统手术组对照，以探讨电视胸腔镜下儿童先心手术的价值。
资料与方法
临床资料
选取2008年1月-2012年12月我院收治56例先天性心脏病患者，均根据体征，经心电图、心脏彩超、X线心脏平片等检查确诊断为先天性心脏病，年龄均>5岁，体重>18 kg，并无其他合并畸形的继发孔型房间隔缺损(atrial septal defect，ASD)和膜部室间隔缺损(ventricular septal defect，VSD)。其中VSD 24例，ASD 32例。根据监护人或患者意愿分为腔镜组26例和传统组30例。腔镜组中男16例，女10例；年龄6～19岁，平均(14.4±8.0)岁；体重(37.6±15.8)kg；心胸比例(0.51±0.03)；术前HB(119±11) g/L；NYHA心功能分级Ⅱ级24例，Ⅲ级2例；ASD 9例，VSD 17例。开胸组中男18例，女12例；年龄6～20岁，平均(15.2±7.9)岁；体重(38.2±15.3)kg；心胸比例(0.52±0.04)；术前HB(118±12)g/L；心功能分级Ⅱ级27例，Ⅲ级3例；ASD 13例，VSD 17例。两组患者一般情况比较无统计学意义(P>0.05)，具有可比性。, 百拇医药(方政)