Kennedy A P, Snyder C L, Ashcraft K W, Manning P B
Department of Surgery, The Children's Mercy Hospital, Kansas City, MO 64108-4698, USA.
J Pediatr Surg. 1998 Feb;33(2):259-61. doi: 10.1016/s0022-3468(98)90442-0.
We reviewed our experience with the treatment of patent ductus arteriosus (PDA), and compared two therapeutic techniques; muscle-sparing thoracotomy (MST) and thoracoscopic PDA ligation (TPDAL).
We reviewed the clinical records and operative reports of 19 nonnewborn patients who were treated at our institution for PDA. Eleven patients underwent TPDAL and eight patients MST. The TPDAL patients underwent thoracoscopic clipping (ligation) of the PDA, whereas the MST group had a complete division of the ductus. A two-tailed Student's t test was used to calculate the 95% confidence intervals for length of operation, number of doses of intravenous narcotics and hospital stay. Costs were also compared.
All patients underwent diagnostic echocardiography in the evaluation of an asymptomatic murmur. Both groups were similar in age (average, 4 years) and gender. All procedures were performed electively. Two thoracoscopic attempts were aborted, one for bleeding and the other for inadequate clip size. The length of the procedure averaged 1.3 hours +/- 0.330 SD for TPDAL versus 1.4 hours +/- 0.335 SD for MST. Five of the nine successful TPDAL patients were admitted to the Pediatric Intensive Care Unit (PICU) with an average length of stay of 20 hours, and two of eight MST patients stayed in the PICU for average of 18 hours. All patients were extubated after the procedure. Chest tubes were placed in two TPDAL patients and three MST patients. However, two patients who underwent TPDAL required tube thoracostomy for persistent postoperative pneumothorax. Average number of intravenous narcotics administered for the TPDAL was 1.2 doses per patient and for MST, 1.75 doses per patient. Mean hospital stay for TPDAL was 1.33 +/- 0.71 SD days and for MST 1.8 +/- 0.83 SD days. Ninety-five percent (95%) confidence intervals for the difference in means demonstrated no difference between the two groups for length of operation, hospital stay, or number of doses of intravenous narcotics administered.
The authors were unable to identify any benefit to thoracoscopic patent ductus arteriosus ligation versus muscle-sparing thoracotomy in terms of hospital stay, length of operation, or morbidity. Additionally, with MST there is a complete division of the PDA theoretically decreasing the risk of recurrence in comparison with clip ligation.
我们回顾了动脉导管未闭（PDA）的治疗经验，并比较了两种治疗技术；保留肌肉的开胸手术（MST）和胸腔镜下PDA结扎术（TPDAL）。
我们回顾了在我院接受PDA治疗的19例非新生儿患者的临床记录和手术报告。11例患者接受了TPDAL，8例患者接受了MST。TPDAL组患者接受了胸腔镜下PDA夹闭（结扎），而MST组则对动脉导管进行了完全切断。采用双尾Student t检验计算手术时间、静脉注射麻醉剂剂量和住院时间的95%置信区间。还比较了费用。
所有患者在评估无症状杂音时均接受了诊断性超声心动图检查。两组患者在年龄（平均4岁）和性别方面相似。所有手术均为择期进行。两次胸腔镜手术尝试中止，一次是因为出血，另一次是因为夹子尺寸不合适。TPDAL组手术平均时长为1.3小时±0.330标准差，MST组为1.4小时±0.335标准差。9例成功接受TPDAL的患者中有5例被收入儿科重症监护病房（PICU），平均住院时间为20小时，8例MST患者中有2例在PICU平均住院18小时。所有患者术后均拔除气管插管。2例TPDAL患者和3例MST患者放置了胸管。然而，2例接受TPDAL的患者因术后持续气胸需要进行胸腔闭式引流术。TPDAL组患者平均静脉注射麻醉剂剂量为每人1.2剂，MST组为每人1.75剂。TPDAL组平均住院时间为1.33±0.71标准差天，MST组为1.8±0.83标准差天。两组在手术时间、住院时间或静脉注射麻醉剂剂量方面，均值差异的95%置信区间显示无差异。
就住院时间、手术时长或发病率而言，作者未能发现胸腔镜下动脉导管未闭结扎术相对于保留肌肉的开胸手术有任何益处。此外，理论上MST对PDA进行了完全切断，与夹闭结扎相比，降低了复发风险。
