全胸腔镜手术与传统正中开胸手术治疗儿童室间隔缺损的疗效比较

Comparison of totally thoracoscopic surgery and conventional median sternotomy for treating ventricular septal defect in children

摘要:

目的 比较全胸腔镜手术与传统正中开胸手术治疗儿童室间隔缺损（VSD）的疗效。方法 回顾性分析2020年6月—2025年6月新疆医科大学第一附属医院收治的98例VSD患儿（0～18岁）的临床资料，根据手术方式分为胸腔镜组与正中开胸组，分别有46、52例。胸腔镜组采取全胸腔镜VSD补片修补术，正中开胸组采取正中开胸VSD补片修补术。比较两组患儿年龄、性别、体重、VSD直径、左心室射血分数（LVEF）、美国纽约心脏病（NYHA）心功能分级、手术时间、体外循环时间、主动脉阻断时间、术中失血量、关胸时间、呼吸机辅助通气时间、重症监护室（ICU）滞留时间、48 h引流量、FLACC疼痛评分、术后住院时间及并发症发生率。结果 胸腔镜组手术时间、体外循环时间和主动脉阻断时间均长于正中开胸组（P <0.05），术中失血量少于正中开胸组（P <0.05），关胸时间短于正中开胸组（P <0.05）。胸腔镜组ICU滞留时间、术后住院时间均短于正中开胸组（P <0.05），48 h引流量少于正中开胸组（P <0.05）。两组呼吸机辅助通气时间比较，差异无统计学意义（P >0.05）。两组术后第1、2、3天FLACC疼痛评分比较，结果 ①不同时间点的FLACC评分比较，差异有统计学意义（P <0.05）；②两组FLACC评分比较，差异有统计学意义（P <0.05），胸腔镜组评分较正中开胸组低，胸腔镜组镇痛效果更明显；③两组FLACC评分的变化趋势比较，差异有统计学意义（P <0.05）。两组术后并发症总发生率比较，差异无统计学意义（P >0.05）。结论 全胸腔镜技术是一种安全、有效的治疗，相较于正中开胸其在减少创伤、加快恢复及安全性方面的优势较大，且术后短期并发症发生率相似。因此，对于体重>35 kg且不适合接受介入封堵手术的VSD儿童，全胸腔镜技术可作为正中开胸修补手术之外一种实用的替代治疗方案。

Abstract:

Objective To investigate the efficacy of totally thoracoscopic surgery versus median sternotomy in the treatment of children with ventricular septal defect (VSD).Methods A retrospective analysis was performed on clinical data from 98 children with VSD (aged 0-18 years) admitted to the First Affiliated Hospital of Xinjiang Medical University from June 2020 to June 2025. According to the surgical approach, 46 patients were assigned to the thoracoscopic group and 52 to the median sternotomy group. The thoracoscopic group underwent totally thoracoscopic VSD patch repair, whereas the median sternotomy group underwent VSD patch repair via median sternotomy. Age, sex, body weight, VSD diameter, left ventricular ejection fraction (LVEF), New York Heart Association (NYHA) functional class, operative time, cardiopulmonary bypass time, aortic cross-clamp time, intraoperative blood loss, chest closure time, duration of mechanical ventilation, intensive care unit (ICU) stay, 48-h drainage volume, FLACC pain score, postoperative hospital stay, and complication rate were compared between the two groups.Results Operative time, cardiopulmonary bypass time, and aortic cross-clamp time were longer in the thoracoscopic group than in the median sternotomy group, whereas intraoperative blood loss was lower and chest closure time was shorter (P < 0.05). ICU stay and postoperative hospital stay were shorter and 48-h drainage volume was lower in the thoracoscopic group (P < 0.05). The duration of mechanical ventilation did not differ significantly between the groups (P > 0.05). Repeated-measures analysis of FLACC scores showed significant effects of time and group and a significant time-by-group interaction (all P < 0.05); scores were lower in the thoracoscopic group, indicating better analgesia. The total incidence of postoperative complications did not differ significantly between the two groups (P > 0.05).Conclusion Totally thoracoscopic surgery is a safe and effective treatment for children with VSD. Compared with median sternotomy, it has significant advantages in reducing surgical trauma, accelerating postoperative recovery, and ensuring safety, with a similar incidence of short-term postoperative complications. Therefore, for children with VSD who are ineligible for interventional occlusion and have a body weight > 35 kg, totally thoracoscopic surgery can serve as a practical alternative to median sternotomy VSD patch repair.