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醫(yī)學(xué)免費(fèi)論文:三種手術(shù)入徑治療房間隔缺損的體外循環(huán)對(duì)比研究
【摘要】 目的 對(duì)比不停跳下房間隔缺損三種手術(shù)入徑的體外循環(huán)(CPB)建立與管理。方法 59例房間隔缺損患者分別采用：胸壁打孔全胸腔鏡(15例)、右腋下小切口(19例)及胸骨正中切口(25例)三種術(shù)式完成，胸腔鏡組采用股動(dòng)、靜脈插管建立CPB;右液下小切口采用升主動(dòng)脈、直角腔靜脈插管建立CPB;正中切口采取常規(guī)插管方法建立CPB。結(jié)果 手術(shù)過程順利，均痊愈出院。胸腔鏡組與胸骨正中切口組比較，輸血量、引流量、術(shù)后住院天數(shù)均顯著降低(P<0.05)，其CPB時(shí)間、手術(shù)時(shí)間也有差別，但無統(tǒng)計(jì)學(xué)意義。右腋下小切口組與胸骨正中切口組比較，胸廓畸形、創(chuàng)傷、輸血量、引流量有顯著性差異(P<0.05)，其術(shù)后住院天數(shù)也有差別，但無統(tǒng)計(jì)學(xué)意義。 結(jié)論 不停跳下房間隔缺損修補(bǔ)術(shù)三種手術(shù)入徑均是安全、可行的，微創(chuàng)小切口更優(yōu)于胸骨正中切口，CPB建立方法雖有所不同，但其管理并無明顯差異。
【關(guān)鍵詞】 體外循環(huán);房間隔缺損;胸腔鏡;右腋下小切口
Comparison of Management of Cardiopulmonary Bypass inThree procedures for repairing Atrial Septal Defect
MA Li-juan,LI Ye,CHEN Hou-kun醫(yī).學(xué).全.在.線m.gydjdsj.org.cn
(Department of Thoracic and Cadiovascular Surgery,the Forth Affiliated Hospital of
Harbin Medical University,Heilongjiang Haerbin150001,China)
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(P<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 (P<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 than median sternotomy.
Key words： Cardiopulmonary bypass;Atrial septal defect;Thoracosopy;right arillary minithoracotomy
2007年1月至2009年7月，我院對(duì)59例房間隔缺損(atral septal defect,ASD)患者經(jīng)胸壁打孔全胸腔鏡、右腋下小切口和胸骨正中切口三種不同手術(shù)入徑，在體外循環(huán)(cardiopulmonary bypass,CPB)心臟不停跳下完成了缺損修補(bǔ)術(shù)。
