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目的探讨非体外循环下经胸壁微创封堵术治疗动脉导管未闭(PDA)的临床疗效。方法选择2008年1月～2012年12月吉林大学第二医院收治的PDA患者32例,分为实验组及对照组,每组各16例。对照组16例接受开胸动脉导管结扎术,实验组16例接受非体外循环下经胸壁微创封堵术。比较两组患者切口长度、术中出血、手术时间、术后48 h内平均体温、术后心率、术后血压、呼吸机辅助时间、抗生素使用天数、血管活性药物及止痛药物使用情况、术中及术后输血、拆线时间及住院天数等情况。结果所有患者均顺利完成手术,实验组无患者术中中转开胸。实验组在切口长度[(4.24±1.74)cm]、术中出血[(18.27±5.38)mL]、手术时间[(0.96±0.33)h]、术后心率[(98.45±9.72)次/min]、术后血压[(15.38±1.26)/(8.79±0.86)kPa]、呼吸机辅助时间[(1.45±0.32)h]、抗生素使用天数[(3.26±0.53)d]、血管活性药物[(3.26±0.53)d]、止痛药物的使用[12.5%(2/16)]、术中及术后输血[0.00(0/16)]、拆线时间[(3.52±0.39)d]、住院天数[(7.38±1.07)d]等优于对照组[(24.13±4.92)cm、(127.52±26.63)mL、(3.71±0.50)h、(126.51±12.94)次/min、(16.68±1.19)/(9.91±0.84)kPa、(20.24±4.12)h、(5.37±0.74)d、37.5%(6/16)、62.5%(10/16)、81.3%(13/16)、(8.21±0.43)d、(14.92±2.42)d],差异均有统计学意义(P<0.05);两组患者术后48 h内平均体温比较[(37.34±0.61)、(37.53±0.48)℃],差异无统计学意义(P>0.05);实验组[6.3%(1/16)]术后并发症的发生情况要明显低于对照组[37.5%(6/16)],差异有统计学意义(χ2=4.571,P<0.05)。结论非体外循环下经胸壁微创封堵术治疗PDA具有创伤小、手术时间短、术后疼痛轻、恢复快、不影响体表美观等优点,值得推广。
Objective To investigate the clinical efficacy of transcatheter closure of patent ductus arteriosus (PDA) by transcatheter closure without cardiopulmonary bypass. Methods Thirty-two PDA patients admitted to the Second Hospital of Jilin University from January 2008 to December 2012 were divided into experimental group and control group, with 16 cases in each group. Control group, 16 patients underwent open thoracic duct ligation, experimental group of 16 patients underwent off-pump minimally invasive transcatheter closure. The incision length, intraoperative bleeding, operation time, mean body temperature within 48 h postoperatively, postoperative heart rate, postoperative blood pressure, ventilator support time, days of antibiotic use, vasoactive drugs and analgesic drug use were compared between the two groups And postoperative blood transfusion, suture removal time and hospitalization days and so on. Results All patients successfully completed the operation, the experimental group without intraoperative thoracotomy. The length of incision (4.24 ± 1.74 cm), intraoperative bleeding (18.27 ± 5.38) mL, operation time (0.96 ± 0.33) h and postoperative heart rate (98.45 ± 9.72) , Postoperative blood pressure [(15.38 ± 1.26) / (8.79 ± 0.86) kPa], ventilator assisted time [(1.45 ± 0.32) h], days of antibiotic use [(3.26 ± 0.53) d], vasoactive drugs ± 0.53) d], the use of analgesics [12.5% (2/16)], intraoperative and postoperative blood transfusions [0.00 (0/16)], stitches offline time [(3.52 ± 0.39) d] (7.38 ± 1.07) d] were significantly higher than those in the control group [(24.13 ± 4.92) cm, (127.52 ± 26.63) mL, (3.71 ± 0.50) h, (126.51 ± 12.94) / 16.68 ± 1.19 / 9.91 ± 0.84) kPa, (20.24 ± 4.12) h, (5.37 ± 0.74) d, 37.5% (6/16), 62.5% (10/16), 81.3% (13/16), (8.21 ± 0.43) d , (14.92 ± 2.42) d] respectively, the differences were statistically significant (P <0.05). The average body temperature in the two groups after operation was (37.34 ± 0.61) and (37.53 ± 0.48) ℃, respectively, The incidence of postoperative complications in experimental group [6.3% (1/16)] was significantly lower than that in control group [37.5% (6/16)], the difference was statistically significant (χ2 = 4.571, P <0.05). Conclusion Transcatheter closure of PDA with minimally invasive transcatheter closure without cardiopulmonary bypass has the advantages of less trauma, shorter operative time, less postoperative pain, quicker recovery and no adverse effect on body appearance. It is worth popularizing.