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目的比较全胸腔镜下房间隔缺损修补术与经胸封堵手术在治疗小儿先天性房间隔缺损中的应用效果。方法2003年4月~2005年6月共收治房间隔缺损患者70例,年龄5.7±2.5岁,均为不适合做介入封堵手术者。依据术中采用的不同手术方法分为两组,全胸腔镜组:在全胸腔镜下行房间隔缺损修补术42例,其中合并三尖瓣关闭不全21例,中、重度肺动脉高压8例,部分型肺静脉畸形引流4例。经胸封堵组:经胸封堵房间隔缺损手术28例,其中合并中、重度肺动脉高压5例,三尖瓣关闭不全4例。对比两组患者的手术时间、重症监护时间、术后呼吸机辅助时间、住院天数等指标,比较两种手术的优势。结果两组均无手术死亡者,术后无并发症发生,痊愈出院。全胸腔镜组手术时间、住院时间均长于经胸封堵组(180.5±17.8minvs.82.5±17.8min,5.2±0.6dvs.3.9±0.5d;P<0.01);而重症监护时间分别为16.67±3.45h和16.23±3.47h,机械通气时间为5.34±0.68h和5.42±0.81h,两组间比较差异无统计学意义。结论两种手术方式的应用对小儿房间隔缺损的治疗均安全可靠,手术创伤小。全胸腔镜房间隔缺损修补术适应证范围大于经胸封堵术,手术难度亦较大。
Objective To compare the effect of thoracoscopic atrial septal defect repair and transthoracic closure in the treatment of congenital atrial septal defect in children. Methods From April 2003 to June 2005, 70 patients with atrial septal defect were admitted, aged 5.7 ± 2.5 years old. All of them were unsuitable for interventional surgery. According to the different surgical methods used in surgery were divided into two groups, the whole thoracoscopic group: undergoing thoracoscopic atrial septal defect repair in 42 cases, including tricuspid regurgitation in 21 cases, moderate and severe pulmonary hypertension in 8 cases, part Pulmonary venous anomalies drainage in 4 cases. Transeptal closure group: Transeptal closure of atrial septal defect surgery in 28 cases, of which merged, severe pulmonary hypertension in 5 cases, tricuspid regurgitation in 4 cases. Compare the two groups of patients operating time, intensive care time, postoperative ventilator support time, hospitalization days and other indicators, compare the advantages of the two kinds of surgery. Results There was no operative death in both groups. No postoperative complications occurred and he was discharged. The operation time and hospital stay of the thoracoscopic group were longer than those of the transthoracic closure group (180.5 ± 17.8min vs 82.5 ± 17.8min, 5.2 ± 0.6d vs.3.9 ± 0.5d; P <0.01), while the duration of intensive care was 16.67 ± 3.45h and 16.23 ± 3.47h, mechanical ventilation time was 5.34 ± 0.68h and 5.42 ± 0.81h, no significant difference between the two groups. Conclusion The application of the two surgical methods for the treatment of children with ASD are safe and reliable, less trauma. Full thoracoscopic atrial septal defect repair indications greater than the scope of transcatheter closure surgery, surgery is also more difficult.