作者：罗洪波，蒋振威，张文斌

单位：

550003贵州省贵阳市，贵州省人民医院心脏外科 通信作者：罗洪波，E-mail：lhbsy810628@163.com

Units：

Department of Cardiac Surgery, Guizhou Provincial People's Hospital, Guiyang 550003, China Corresponding author: LUO Hongbo, E-mail: lhbsy810628@163.com

关键词：

心脏病; 先天性心脏病; 微创外科手术; 胸骨下端小切口微创手术; 传统开胸手术; 治疗结果;

Keywords：

Heart diseases; Congenital heart disease; Minimal surgical procedures; Minimally invasive surgery with small incision at the lower end of the sternum; Traditional thoracotomy; Treatment outcome

CLC：

DOI：

10.12114/j.issn.1008-5971.2022.00.261

Funds：

2022年度贵州省健康委科学技术基金项目（gzwkj2022-095）；贵州省科技计划项目（黔科合LH字【2016】7181）

摘要：

目的 探讨胸骨下端小切口微创手术治疗先天性心脏病的效果。方法 回顾性选取2016年8月至2021年3月于贵州省人民医院行手术治疗的先天性心脏病患者332例为研究对象。根据手术方法将患者分为胸骨下端小切口微创手术组和传统开胸手术组，各166例。比较两组基线资料、手术相关指标(手术时间、体外循环时间、主动脉阻断时间、术后引流量)、呼吸机使用时间、ICU停留时间、安全性指标(术后并发症发生情况)、预后指标(非计划再次手术情况、围术期死亡情况)。结果 胸骨下端小切口微创手术组年龄小于传统开胸手术组，体质量、肺静脉异位引流(APVC)发生率高于传统开胸手术组(P<0.05)。胸骨下端小切口微创手术组手术时间、体外循环时间、主动脉阻断时间、呼吸机使用时间、ICU停留时间短于传统开胸手术组，术后引流量小于传统开胸手术组(P<0.05)。胸骨下端小切口微创手术组术后并发症发生率低于传统开胸手术组(P<0.05)。两组无一例患者进行非计划再次手术及发生围术期死亡。结论 胸骨下端小切口微创手术可有效缩短先天性心脏病患者的手术时间及ICU停留时间，促进患者康复，虽然其操作难度稍大，但术者完全能够克服，且其安全性好，值得广泛推广。

Abstract：

【Abstract】　Objective To investigate the effect of minimally invasive surgery with small incision at the lower end of the sternum in the treatment of congenital heart disease. Methods A total of 332 patients with congenital heart disease who underwent surgical treatment in Guizhou Provincial People's Hospital from August 2016 to March 2021 were retrospectively selected as the research subjects. According to the surgical method, the patients were divided into minimally invasive surgery with small incision at the lower end of the sternum group and traditional thoracotomy group, with 166 cases in each group. The baseline data, surgery-related indicators (operation time, cardiopulmonary bypass time, aortic occlusion time, postoperative drainage volume) , ventilator use time, ICU stay time, safety indicators (postoperative complications) , and prognostic indexes (non-planned surgery, perioperative death) . Results The age of the minimally invasive surgery with small incision at the lower end of the sternum group was younger than that of the traditional thoracotomy group, and the body weight and the incidence of anomalous pulmonary venous connection (APVC) were higher than those in the traditional thoracotomy group (P < 0.05) . The operation time, cardiopulmonary bypass time, aortic occlusion time, ventilator use time, and ICU stay time in the minimally invasive surgery with small incision at the lower end of the sternum group were shorter than those in the traditional thoracotomy group, and the postoperative drainage volume was smaller than that in the traditional thoracotomy group (P < 0.05) . The incidence of postoperative complications in the minimally invasive surgery with small incision at the lower end of the sternum group was lower than that in the traditional thoracotomy group ( P < 0.05) . No non-planned surgery or perioperative death occurred in any patient in the two groups. Conclusion Minimally invasive surgery with small incision at the lower end of the sternum can effectively shorten the operation time and ICU stay time of patients with congenital heart disease, and promote the recovery of patients. Although the operation is slightly difficult, the operator can completely overcome it, and its safety is good, so it is worth popularizing widely.

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