三种手术入径治疗房间隔缺损体外循环对比探究.doc

三种手术入径治疗房间隔缺损体外循环对比探究 　【摘要】 目的 对比不停跳下房间隔缺损三种手术入径的体外循环(CPB)建立与管理。方法 59例房间隔缺损患者分别采用：胸壁打孔全胸腔镜(15例)、右腋下小切口(19例)及胸骨正中切口(25例)三种术式完成，胸腔镜组采用股动、静脉插管建立CPB;右液下小切口采用升主动脉、直角腔静脉插管建立CPB;正中切口采取常规插管方法建立CPB。结果 手术过程顺利，均痊愈出院。胸腔镜组与胸骨正中切口组比较，输血量、引流量、术后住院天数均显著降低(Plt;0.05)，其CPB时间、手术时间也有差别，但无统计学意义。右腋下小切口组与胸骨正中切口组比较，胸廓畸形、创伤、输血量、引流量有显著性差异(Plt;0.05)，其术后住院天数也有差别，但无统计学意义。 结论 不停跳下房间隔缺损修补术三种手术入径均是安全、可行的，微创小切口更优于胸骨正中切口，CPB建立方法虽有所不同，但其管理并无明显差异。 【关键词】 体外循环;房间隔缺损;胸腔镜;右腋下小切口 　　Abstract: OBJECTIVE To compare the method and management of cardiopulmonary bypass by three operative approaches with open beating heart surgery for repairing atrial septal defect. METHODS 59 patients were treated with three different operative approaches:15 patients underwent thoracoscopy;19 patients underwent right axillary minithoracotomy and 25 patients underwent median sternotomy operation. The thoracoscopy operation group used femoral artery and vein cannulation to establish CPB; Right arillary minithoracotomy group used ascending aorta and right angle vena cava cannulation to establish CPB; Median sternotomy group used regular cannulation to establish CPB. RESULTS Operations were successful and all patients recovered well.Comparing to median sternotomy, the thoracoscopy operation group has advantages including minithoracotomy, no need to wound sternum, less hemorrhage and drainage, and shorter hospitalization days(Plt;0.05).There were also differences in bypass time and operation time,but no statistic difference;there were differences in trauma,chest malformation,hemorrhage,drainage between right arillary minithoracotomy and regular median sternotomy (Plt;0.05),but no statistic difference in hospitalization days. CONCLUSION Though the ways of cardiopulmonary bypass by three operative approaches with open beating heart surgery were different, the management of cardiopulmonary bypass was no significant difference. The three operative approaches were all safe and technically feasible but minimal invasive approach was better