Chen Yong,Mo Xuming,Chen Runsen,et al.A comparative study of right subaxillary small incision approach and traditional median sternal incision approach for ventricular septal defect[J].Journal of Clinical Pediatric Surgery,,22():419-424.[doi:10.3760/cma.j.cn101785-202305005-004]
A comparative study of right subaxillary small incision approach and traditional median sternal incision approach for ventricular septal defect
- Keywords:
- Heart Diseases; Congenital Abnormalities; Minimally Invasive Surgical Procedures; Surgical Procedures; Operative; Child
- Abstract:
- Objective To compare the clinical efficacy,safety and effectiveness of small right axillary incision versus traditional median sternal incision for ventricular septal defect (VSD).Methods The relevant clinical data were retrospectively reviewed for 937 hospitalized VSD children from October 2020 to January 2023.They were divided into two groups of right axillary incision (n=487) and median incision (n=450) according to surgical approach.The major observation parameters included operative duration,extracorporeal circulation time,aortic block time,volume of intraoperative hemorrhage,volume of postoperative drainage,postoperative ventilator-assisted time,postoperative hospitalization time,incidence of postoperative pulmonary atelectasis,diaphragmatic elevation,celiac disease and chicken chest.Results In right subaxillary small incision and median incision groups,the differences were not statistically significant in operative duration [(151.1±9.1) vs.(151.4±11.3) min],extracorporeal circulation time [(55.4±2.0) vs.(55.4±2.1) min]or aortic block time[(30.0±1.7) vs.(30.2±1.7) min](P>0.05).And volume of intraoperative hemorrhage [(90.5±6.6) vs.(106.8±15.6) ml],volume of postoperative drainage [(95.1±12.0) vs.(172.7±15.3) ml],postoperative ventilator-assisted time [(9.4±0.9) vs.(11.6±1.4) h],postoperative monitoring time[(33.7±5.6) vs.(42.4±9.6) h]and postoperative hospital stay [(9.1±1.1) vs.(11.1±1.2) d]were superior in right subaxillary incision group to those in median incision group.There were statistically significant differences (P<0.05).As for the incidence of postoperative pulmonary atelectasis,diaphragmatic elevation and celiac disease,there was no statistically significant inter-group difference (P>0.05).The incidence of chicken chest was higher in median incision group than in right axillary incision group with a statistically significant difference (P<0.05).No other serious complications occurred during a follow-up period of (3-18) months.Conclusion As compared with traditional median incision,right axillary incision offers the advantages of cosmetic incision,less intraoperative hemorrhage,faster recovery and shorter hospitalization time.And the clinical outcomes are both safe and reliable.
References:
[1] 胡盛寿.先天性心脏病外科治疗中国专家共识[J].中国胸心血管外科临床杂志,2021,28(1):1-3.DOI 10.7507/1007-4848.202011071. Hu SS.Commentary on Chinese Expert Consensus on Surgery for Congenital Heart Diseases[J].Chin J Clin Thorac Cardiovasc Surg,2021,28(1):1-3.DOI:10.7507/1007-4848.202011071.
[2] Lytzen R,Vejlstrup N,Bjerre J,et al.Live-born major congenital heart disease in Denmark:incidence,detection rate,and termination of pregnancy rate from 1996 to 2013[J].JAMA Cardiol,2018,3(9):829-837.DOI:10.1001/jamacardio.2018.2009.
[3] 王鹏高,张宇,陈忠建,等.右腋下小切口入路手术治疗先天性心脏病患儿的临床疗效[J].中华实用儿科临床杂志,2020,35(1):41-45.DOI:10.3760/cma.j.issn.2095-428X.2020.01.011. Wang PG,Zhang Y,Chen ZJ,et al.Clinical effect of right subaxillary small incision approach on children with congenital heart disease[J].Chin J Appl Clin Pediatr,2020,35(1):41-45.DOI:10.3760/cma.j.issn.2095-428X.2020.01.011.
[4] 中华医学会儿科学分会心血管学组,中国医师协会儿科医师分会先天性心脏病专家委员会,《中华儿科杂志》编辑委员会.胎儿先天性心脏病诊断及围产期管理专家共识[J].中华儿科杂志,2015,53(10):728-733.DOI:10.3760/cma.j.issn.0578-1310.2015.10.004. Group of Cardiovascular Diseases,Branch of Pediatrics,Chinese Medical Association,Congenital Heart Disease Expert Committee of Pediatric Branch of Chinese Medical Doctor Association,Editorial Committee of Chinese Journal of Pediatrics:Expert Consensus on Diagnosis and Perinatal Management of Fetal Congenital Heart Disease[J].Chin J Pediatr,2015,53(10):728-733.DOI:10.3760/cma.j.issn.0578-1310.2015.10.004.
[5] Sun RR,Liu M,Lu L,et al.Congenital heart disease:causes,diagnosis,symptoms,and treatments[J].Cell BiochemBiophys,2015,72(3):857-860.DOI:10.1007/s12013-015-0551-6.
[6] 宋杰,王波,宋来春,等.不同微创小切口与胸骨正中切口治疗儿童先天性室间隔缺损的临床对比研究[J].中国心血管病研究,2018,16(3):242-245.DOI:10.3969/j.issn.1672-5301.2018.03.014. Song J,Wang B,Song LC,et al.Evaluation of different mini-invasive techniques in surgical correction of congenital ventricular septal defect[J].Chin J Cardiovasc Res,2018,16(3):242-245.DOI:10.3969/j.issn.1672-5301.2018.03.014.
[7] 王明海,曹素文,徐振海,等.经右胸外侧小切口矫治小儿先天性心脏畸形90例[J].中华胸心血管外科杂志,2001,17(1):53-54.DOI:10.3760/cma.j.issn.1001-4497.2001.01.035. Wang MH,Cao SW,Xu ZH,et al.Correction of congenital heart malformation in children with a small incision in right lateral chest:a report of 90 cases[J].Chin J Thorac Cardiovasc Surg,2001,17(1):53-54.DOI:10.3760/cma.j.issn.1001-4497.2001.01.035.
[8] 李晓锋,苏俊武,张晶,等.右侧腋下小切口入路矫治法洛四联症的技术要点分析[J].中华解剖与临床杂志,2014,19(3):180-182.DOI:10.3760/cma.j.issn.2095-7041.2014.03.002. Li XF,Su JW,Zhang J,et al.Key surgical techniques for complete correction of tetralogy of Fallot through right mini-lateral thoracotomy[J].Chin J Anat Clin,2014,19(3):180-182.DOI:10.3760/cma.j.issn.2095-7041.2014.03.002.
[9] 王东进,吴清玉,杨秀滨,等.右腋下直切口在体外循环心脏直视手术中的应用[J].中国胸心血管外科临床杂志,2007,14(6):468-470.DOI:10.3969/j.issn.1007-4848.2007.06.018. Wang DJ,Wu QY,Yang XB,et al.Cardiac surgery through a minimal right vertical infra-axillary thoracotomy[J].Chin J Clin Thorac Cardiovasc Surg,2007,14(6):468-470.DOI:10.3969/j.issn.1007-4848.2007.06.018.
[10] Gil-Jaurena JM,Zabala JI,Conejo L,et al.Minimally invasive pediatric cardiac surgery.Atrial septal defect closure through axillary and submammary approaches[J].Rev Esp Cardiol,2011,64(3):208-212.DOI:10.1016/j.recesp.2010.08.009.
[11] 胡义杰,钟前进,陈建明,等.右侧腋下小切口先天性心脏病直视手术的临床应用[J].中国胸心血管外科临床杂志,2012,19(4):427-429. Hu YJ,Zhong QJ,Chen JM,et al.Clinical application of right small axillary incision during open heart surgery[J].Chin J Clin Thorac Cardiovasc Surg,2012,19(4):427-429.
[12] 张涛,葛建军,张海洋,等.右腋下小切口与胸骨正中切口入路手术治疗儿童简单先天性心脏病疗效比较的回顾性研究[J].现代生物医学进展,2022,22(6):1056-1059.DOI:10.13241/j.cnki.pmb.2022.06.012. Zhang T,Ge JJ,Zhang HY,et al.Retrospective study on efficacy comparison of right subaxillary small incision versus median sternal incision for simple congenital heart disease in children[J].Prog Mod Biomed,2022,22(6):1056-1059.DOI:10.13241/j.cnki.pmb.2022.06.012.
[13] 张涛,葛建军,张海洋,等.右腋下小切口与胸骨正中切口入路手术治疗儿童简单先天性心脏病疗效比较的回顾性研究[J].现代生物医学进展,2022,22(6):1056-1059.DOI:10.13241/j.cnki.pmb.2022.06.012. Zhang T,Ge JJ,Zhang HY,et al.Retrospective study on efficacy comparison of right subaxillary small incision versus median sternal incision for simple congenital heart disease in children[J].Prog Mod Biomed,2022,22(6):1056-1059.DOI:10.13241/j.cnki.pmb.2022.06.012.
[14] 王金龙.右外侧小切口与胸骨正中切口治疗小儿先天性心脏病的对比研究[D].南宁:广西医科大学,2015:44-45. Wang JL.Right LSTER mini-thoracotomy versus conventional median sternotomy in the treatment of infantile congenital heart disease[D].Nanning:Guangxi Medical University,2015:44-45.
[15] 刘炫,白上林,佘凯,等.微创右侧腋下小切口手术入路治疗小儿先天性心脏病的临床研究[J].现代医药卫生,2022,38(11):1935-1937.DOI:10.3969/j.issn.1009-5519.2022.11.033. Liu X,Bai SL,She K,et al.Clinical study of mini-invasive right axillary small incision surgical approach for children with congenital heart disease[J].J Mod Med Health,2022,38(11):1935-1937.DOI:10.3969/j.issn.1009-5519.2022.11.033.
[16] 刘炫,白上林,佘凯,等.微创右侧腋下小切口手术入路治疗小儿先天性心脏病的临床研究[J].现代医药卫生,2022,38(11):1935-1937.DOI:10.3969/j.issn.1009-5519.2022.11.033. Liu X,Bai SL,She K,et al.Clinical study of mini-invasive right axillary small incision surgical approach for children with congenital heart disease[J].J Mod Med Health,2022,38(11):1935-1937.DOI:10.3969/j.issn.1009-5519.2022.11.033.
[17] An GY,Zhang HY,Zheng SG,et al.Mid-term outcomes of common congenital heart defects corrected through a right subaxillary thoracotomy[J].Heart Lung Circ,2017,26(4):376-382.DOI:10.1016/j.hlc.2015.05.028.
[18] An GY,Zhang HY,Zheng SG,et al.Minimally invasive surgical closure for doubly committed subarterial ventricular septal defects through a right subaxillary thoracotomy[J].Interact Cardiovasc Thorac Surg,2016,23(6):924-928.DOI:10.1093/icvts/ivw255.
[19] Dave HH,Comber M,Solinger T,et al.Mid-term results of right axillary incision for the repair of a wide range of congenital cardiac defects[J].Eur J Cardiothorac Surg,2009,35(5):864-870.DOI:10.1016/j.ejcts.2009.01.022.
[20] del Nido PJ.Minimal incision congenital cardiac surgery[J].Semin Thorac Cardiovasc Surg,2007,19(4):319-324.DOI:10.1053/j.semtcvs.2007.12.004.
Memo
收稿日期:2023-5-2。
基金项目:国家自然科学基金面上项目(81970265);江苏省科技计划(资金)重大科技示范项目(BE2023710006)
通讯作者:莫绪明,Email:mohsuming15@sina.com