摘要
目的探究经右胸小切口心脏直视手术治疗先天性心脏病(congenital heart disease,CHD)患儿的疗效。方法回顾性分析2016年2月至2018年12月于徐州市儿童医院行心脏直视手术治疗的121例CHD患儿的临床资料,根据患儿手术切口将其分为小切口组(右胸小切口术式,65例)和正中切口组(正中切口术式,56例)。记录两组患儿手术相关指标、术后恢复情况和术后并发症发生情况,比较两组患儿术前和术后1 d应激反应发生情况(促肾上腺皮质激素、皮质醇),术后3个月和6个月切口瘢痕状况(温哥华瘢痕量表)、家属瘢痕满意度(数字评分系统)。结果两组患儿体外循环时间、手术时间比较差异均无统计学意义(均P>0.05);小切口组患儿术中出血量、术后1 d胸腔引流量均显著少于正中切口组(均P<0.05),术后呼吸机辅助时间、术后住院天数均显著短于正中切口组(均P<0.05),术后并发症总发生率显著低于正中切口组(P<0.05)。术后1 d,两组患儿血清促肾上腺皮质激素、皮质醇水平均显著高于本组术前(均P<0.05),正中切口组患儿血清促肾上腺皮质激素、皮质醇水平均显著高于小切口组(均P<0.05)。术后3个月和6个月,小切口组患儿温哥华瘢痕量表评分均显著低于同期正中切口组(均P<0.05),家属瘢痕满意度均显著高于同期正中切口组(均P<0.05)。结论经右胸小切口入路心脏直视手术治疗CHD患儿的效果优于传统正中切口术式,能显著减轻手术创伤,改善患儿切口瘢痕状况,提高家属瘢痕满意度。
Objective To explore the efficacy of open heart surgery through right thoracotomy small incision in children with congenital heart disease(CHD).Method The clinical data of 121 children with CHD who underwent open heart surgery in Xuzhou Children's Hospital were retrospectively analyzed.According to the surgical incision,they were divided into small incision group(right thoracotomy small incision surgery,65 cases)and median incision group(median incision surgery,56 cases).The surgical related indexes,postoperative recovery and occurrence of postoperative complications were recorded in the two groups,the occurrence of stress response before and 1 d after surgery was compared between the two groups(adrenocorticotrophic hormone,cortisol).The incision scar status(Vancouver scar scale)and family scar satisfaction(numerical score system)at 3 months and 6 months after surgery were compared.Result There were no significant differences in the cardiopulmonary bypass time and surgical time between the two groups(all P>0.05).The intraoperative blood loss and thoracic drainage volume at 1 d after surgery in small incision group were less than those in median incision group(all P<0.05),and the postoperative ventilator assisting time and postoperative hospital days were shorter than those in median incision group(all P<0.05),and the total incidence rate of postoperative complications was lower than that in median incision group(P<0.05).At 1 d after surgery,the levels of serum adrenocorticotrophic hormone and cortisol in the two groups were significantly higher than those before surgery(all P<0.05),and the levels of the above indicators in median incision group were obviously higher than those in small incision group(all P<0.05).At 3 months and 6 months after surgery,the Vancouver scar scale score in small incision group was significantly lower than that at the same time in median incision group(all P<0.05),while the family scar satisfaction was significantly higher than that at the same time in median incision group(all P<0.05).Conclusion Open heart surgery through right thoracotomy small incision has better effects than traditional median incision surgery.It can significantly reduce the surgical trauma and improve the incision scar status of children and family scar satisfaction.
作者
殷士燕
苗春华
丁丽娅
刘红
Yin Shiyan;Miao Chunhua;Ding Liya;Liu Hong(Department of Cardiothoracic Surgery,Xuzhou Children's Hospital,Jiangsu,Xuzhou 221000,China)
出处
《中国医学前沿杂志（电子版）》
2021年第5期93-97,共5页
Chinese Journal of the Frontiers of Medical Science(Electronic Version)
关键词
先天性心脏病
心脏直视手术
右胸小切口
正中切口
瘢痕
Congenital heart disease
Open heart surgery
Right thoracotomy small incision
Median incision
Scar
