经乳晕入路胸腔镜三孔手术与右胸小切口手术治疗成人房间隔缺损的对比。
Triport periareolar thoracoscopic surgery versus right minithoracotomy for repairing atrial septal defect in adults.
机构信息
Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
The First Clinical Medical College, Nanjing Medical University, Nanjing, China.
出版信息
Interact Cardiovasc Thorac Surg. 2021 Jan 22;32(2):313-318. doi: 10.1093/icvts/ivaa246.
OBJECTIVES
Our goal was to investigate the safety and feasibility of triport periareolar thoracoscopic surgery (TPTS) and its advantages in repairing adult atrial septal defect.
METHODS
Between January 2017 and January 2020, a total of 121 consecutive adult patients underwent atrial septal defect closure in our institution. Of these, 30 patients had TPTS and 31 patients had a right minithoracotomy (RMT). Operational data and clinical outcomes were compared between the 2 groups.
RESULTS
The total operation time, cardiopulmonary bypass time and aortic cross-clamp time in the TPTS group were slightly longer than those in the RMT group, but there were no differences between the 2 groups. Compared with the RMT group, the TPTS group showed a decrease in the volume of chest drainage in 24 h (98.6 ± 191.2 vs 222.6 ± 217.2 ml; P = 0.032) and a shorter postoperative hospital stay (6.5 ± 1.5 vs 8.0 ± 3.7 days; P = 0.042). The numeric rating scale on postoperative day 7 was significantly less in the TPTS group than in the RMT group (2.82 ± 1.14 vs 3.56 ± 1.42; P = 0.034). The patient satisfaction scale for the cosmetic results in the TPTS group was significantly higher than in the RMT group (4.68 ± 0.55 vs 4.22 ± 0.76; P = 0.012). No differences were found in postoperative complications. No in-hospital death or major adverse events occurred in the 2 groups.
CONCLUSIONS
TPTS is safe and feasible for the closure of adult atrial septal defect. Compared with RMT, it has been associated with less pain and better cosmetic outcomes.
目的
本研究旨在探讨三孔经乳晕入路胸腔镜手术（TPTS）治疗成人房间隔缺损的安全性和可行性，及其在修复成人房间隔缺损方面的优势。
方法
2017 年 1 月至 2020 年 1 月，我院共对 121 例连续成人患者行房间隔缺损封堵术，其中 30 例行 TPTS，31 例行右小开胸术（RMT）。比较两组患者的手术相关数据和临床结果。
结果
TPTS 组患者的总手术时间、体外循环时间和主动脉阻断时间略长于 RMT 组，但两组间无差异。与 RMT 组相比，TPTS 组术后 24 小时胸腔引流量更少（98.6 ± 191.2 比 222.6 ± 217.2 ml；P = 0.032），术后住院时间更短（6.5 ± 1.5 比 8.0 ± 3.7 天；P = 0.042）。TPTS 组术后第 7 天的数字评分量表评分显著低于 RMT 组（2.82 ± 1.14 比 3.56 ± 1.42；P = 0.034）。TPTS 组患者对美容效果的满意度评分显著高于 RMT 组（4.68 ± 0.55 比 4.22 ± 0.76；P = 0.012）。两组患者术后并发症发生率无差异。两组均无院内死亡或重大不良事件发生。
结论
TPTS 治疗成人房间隔缺损是安全可行的，与 RMT 相比，TPTS 术后疼痛较轻，美容效果更好。
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