婴儿经右腋下小切口治疗先天性心脏病的疗效分析

Effect analysis of congenital heart disease treated by right subaxillary thoracotomy in infants

摘要:

目的 探讨经右腋下小切口建立体外循环在婴儿心内直视手术中应用的效果。方法 回顾性分析2018年6月—2022年2月在新疆医科大学第一附属医院小儿心胸外科接受心脏手术的185例先天性心脏病（CHD）患儿（3～12个月），其中房间隔缺损98例，室间隔缺损87例。将两组患儿按照手术方法不同分为胸骨正中切口组（A组）与右侧腋下小切口组（B组）。比较A、B组房间隔缺损与室间隔缺损患儿手术时间、体外循环时间、主动脉阻断时间、术后住院时间、ICU滞留时间、呼吸机插管时间、术后24 h胸腔引流量、FLACC评分、患儿家属切口满意度及并发症发生情况。结果 房间隔缺损患儿A、B组手术时间、体外循环时间、主动脉阻断时间比较，差异均无统计学意义（P >0.05）。房间隔缺损患儿B组住院时间、ICU滞留时间、呼吸机插管时间短于A组（P <0.05），术后24 h胸腔引流量少于A组（P <0.05）。房间隔缺损患儿不同时间点的FLACC评分有差异（P <0.05）；两组的FLACC评分有差异（P <0.05），B组低于A组；两组FLACC评分的变化趋势有差异（P <0.05）。房间隔缺损患儿家属满意度评分B组高于A组（P <0.05）。房间隔缺损患儿术后均未出现相关并发症。室间隔缺损患儿A、B两组手术时间、体外循环时间、主动脉阻断时间比较，差异均无统计学意义（P >0.05）。室间隔缺损患儿B组住院时间、ICU滞留时间、呼吸机插管时间均短于A组（P <0.05），术后24 h胸腔引流量少于A组（P <0.05）。室间隔缺损患儿不同时间点的FLACC评分有差异（P <0.05）；两组的FLACC评分有差异（P <0.05），B组低于A组；两组FLACC评分的变化趋势无差异（P >0.05）。室间隔缺损患儿家属B组切口满意度评分高于A组（P <0.05）。室间隔缺损患儿A组有2例出现胸廓畸形，1例切口感染；B组出现1例术后肺不张。结论 在婴儿群体中经右腋下小切口治疗CHD，切口隐蔽、美观，对患儿的身体及心理创伤小，住院时间缩短，术后呼吸机插管时间缩短、胸腔引流量减少，能有效减轻疼痛，更容易被患儿及其家属接受，临床疗效优于正中开胸。

Abstract:

Objective To investigate the application effect of establishing extracorporeal circulation through a small incision under the right axilla in infants undergoing direct vision heart surgery.Methods A retrospective analysis was conducted on 185 cases of congenital heart disease in children (aged 3 to 12 months) who underwent cardiac surgery in the Pediatric Cardiothoracic Surgery Department of the First Affiliated Hospital of Xinjiang Medical University from June 2018 to February 2022. Among them, 98 cases had atrial septal defect, and 87 cases had ventricular septal defect. The patients were divided into two groups: the mid-sternum incision group (group A) and the right axillary small incision group (group B), based on different surgical methods. The surgical time, extracorporeal circulation time, aortic clamping time, postoperative hospital stay, ICU stay, duration of endotracheal intubation, chest drainage volume in the first 24 hours after surgery, FLACC score, satisfaction of children's families with the incision, and the occurrence of complications were compared between groups A and B for children with atrial and ventricular septal defects.Results For children with atrial septal defect, there were no statistically significant differences in surgical time, extracorporeal circulation time, and aortic clamping time between groups A and B (P > 0.05). The hospital stay, ICU stay, and duration of endotracheal intubation in group B were shorter than those in group A (P < 0.05), and the chest drainage volume in the first 24 hours after surgery was less than that in group A (P < 0.05). There were differences in FLACC scores at different time points for children with atrial septal defects (P < 0.05), and the FLACC score in group B was lower than that in group A (P < 0.05). The changes in FLACC scores between the two groups showed a significant difference (P < 0.05). The satisfaction score of children's families in group B was higher than that in group A (P < 0.05). No related complications occurred in children with atrial septal defects after surgery. For children with ventricular septal defect, there were no statistically significant differences in surgical time, extracorporeal circulation time, and aortic clamping time between groups A and B (P > 0.05). The hospital stay, ICU stay, and duration of endotracheal intubation in group B were shorter than those in group A (P < 0.05), and the chest drainage volume in the first 24 hours after surgery was less than that in group A (P < 0.05). There were differences in FLACC scores at different time points for children with ventricular septal defects (P < 0.05), and the FLACC score in group B was lower than that in group A (P < 0.05). The changes in FLACC scores between the two groups showed no significant difference (P > 0.05). The satisfaction score of children's families in group B was higher than that in group A (P < 0.05). Two cases of chest deformity and one case of incision infection occurred in group A for children with ventricular septal defects; one case of postoperative lung collapse occurred in group B.Conclusion In the infant population, the treatment of congenital heart disease through a small incision under the right axilla is concealed, aesthetically pleasing, and causes minimal physical and psychological trauma to children. It results in shorter hospital stays, reduced postoperative duration of endotracheal intubation, decreased chest drainage volume, effective pain relief, better acceptance by children and their families, and superior clinical treatment outcomes compared to median sternotomy for congenital heart disease.