彭俊佳 王吉祥 余淑华

[摘要] 目的 探讨在食道超声协助下经右胸小切口完成室间隔缺损修补术与传统胸骨正中切口治疗室间隔缺损的疗效。 方法 选取2015年6月至2019年12月在我院行食道超声心动图辅助下经右胸小切口室间隔缺损修补术的45例室间隔缺损患者为研究组，经正中切口进行室间隔缺损修补术的32例室间隔缺损患者为对照组。比较术后并发症发生率及心功能恢復指标，评估两种手术方式的治疗效果。 结果 两组均未发生低心排综合征、二次开胸止血、死亡、残余漏，差异无统计学意义（P>0.05）;研究组未发现鸡胸，对照组发生3例，差异有统计学意义（P<0.05）;研究组和对照组的血管药物使用时间及手术时间[（12.2±1.3）h，（123.3±12.6）min;（13.3±3.2）h，（126.6±13.6）min]比较，差异无统计学意义（P>0.05）;研究组和对照组术后引流量及下床活动时间[（192.2±30.5）mL，（1.2±0.5）d;（258.8±37.5）mL，（2.2±0.8）d]、肺部感染发生率（4.4%、9.3%）比较，差异均有统计学意义（P<0.05）。 结论 该手术方式效果确切，较传统手术切口小、创伤小、痛苦小、患者恢复快。

[关键词] 经食道超声心动图;室间隔缺损;右胸小切口;术后并发症

[中图分类号] R654.2          [文献标识码] B          [文章编号] 1673-9701（2021）34-0052-04

[Abstract] Objective To explore and compare the effect of the small right chest incision with the assistance of esophageal ultrasound and traditional median sternal incision in the treatment of the ventricular septal defect. Methods From June 2015 to December 2019 in our hospital， 45 patients with ventricular septal defect repaired through a small right chest incision assisted by esophageal echocardiography were selected as the study group. Thirty-two patients with ventricular septal defect who underwent ventricular septal ischemia repair through a median incision served as the control group. The postoperative complication rate and the index of heart function recovery were compared to evaluate the therapeutic effect of the two surgical methods. Results No low cardiac output syndrome， secondary thoracotomy to stop bleeding， death， or residual leakage occurred in the two groups，the difference was not statistically significant（P>0.05）; No pectus carinatum was found in the study group， 3 cases occurred in the control group， and the difference was significant （P<0.05）;There was no significant difference in the use time of vascular drugs and operation time [（12.2±1.3）h， （123.3±12.6）min; （13.3±3.2）h， （126.6±13.6）min] between the study group and the control group （P>0.05）. There are significant statistical differences in postoperative drainage and time of getting out of bed [（192.2±30.5）mL， （1.2±0.5）d; （258.8±37.5）mL， （2.2±0.8）d]， the incidence of lung infection （4.4%， 9.3%） in the study group and control group （P<0.05）. Conclusion This surgical method is effective， with a smaller incision， less trauma， and less pain than traditional surgical methods， and the patient recovers quickly.

[Key words] Transesophageal echocardiography; Ventricular septal defect; Small right chest incision; Postoperative complications

室间隔缺损是最由胚胎期原始室间隔发育障碍而在左右心室之间形成的异常交通，是最常见的先天性心脏病，血流动力学变化主要取决于缺损大小，两侧心室压力差和肺血管阻力变化，临床上发展至晚期可出现艾森曼格综合征。室间隔缺损也是心外科最先开展的心内直视手术之一，经典的手术方式为经胸骨正中切口，心脏冷灌注停跳下完成补片修补或直接缝合修补[1]，但是该手术方式切口长，创伤大，对患者有较大的伤害[2]。随着医学发展和技术的进步，室间隔缺损治疗已经逐渐向微创、介入发展，包括超声引导下经胸封堵术，经皮超声引导下介入室间隔封堵术等，不同的手术方式都有各自的优劣[3-4]，但是室间隔缺损与周围结构的边距局限了介入封堵术适用性。对于……