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中华腔镜外科杂志(电子版)

中华腔镜外科杂志(电子版) ›› 2024, Vol. 17 ›› Issue (04) : 244 -249. doi: 10.3877/cma.j.issn.1674-6899.2024.04.010

论著

微创切口联合腹腔镜同期治疗先天性心脏病合并心外畸形
王双兴1, 吴永杰2, 孟兵2, 张宏涛2, 刁美3, 张辉2,†()   
  1. 1. 100020　北京，首都儿科研究所附属儿童医院心脏外科；100730　北京，北京协和医学院/中国医学科学院
    2. 100020　北京，首都儿科研究所附属儿童医院心脏外科
    3. 100020　北京，首都儿科研究所附属儿童医院普通外科
  • 收稿日期:2024-06-27 出版日期:2024-08-30
  • 通信作者: 张辉
  • 基金资助:
    首都儿科研究所所级课题资助(LCYJ-2025-21，LCYJ-2023-25)

Combined minimally invasive incision and laparoscopy for simultaneous treatment of congenital heart disease with extracardiac anomalies

Shuangxing Wang1, Yongjie Wu2, Bing Meng2, Hongtao Zhang2, Mei Diao3, Hui Zhang2,†()   

  1. 1. Department of Cardiac Surgery, Children′s Hospital Capital Institute of Pediatrics, Beijing 100020, China; Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
    2. Department of Cardiac Surgery, Children′s Hospital Capital Institute of Pediatrics, Beijing 100020, China
    3. Department of General Surgery, Children′s Hospital Affiliated to the Capital Institute of Paediatrics, Beijing 100020, China
  • Received:2024-06-27 Published:2024-08-30
  • Corresponding author: Hui Zhang
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王双兴, 吴永杰, 孟兵, 张宏涛, 刁美, 张辉. 微创切口联合腹腔镜同期治疗先天性心脏病合并心外畸形[J]. 中华腔镜外科杂志(电子版), 2024, 17(04): 244-249.

Shuangxing Wang, Yongjie Wu, Bing Meng, Hongtao Zhang, Mei Diao, Hui Zhang. Combined minimally invasive incision and laparoscopy for simultaneous treatment of congenital heart disease with extracardiac anomalies[J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2024, 17(04): 244-249.

目的

探讨微创切口联合腹腔镜同期治疗先天性心脏病合并心外畸形安全性及可行性。

方法

选取2015年11月至2023年4月于首都儿科研究所附属儿童医院心脏外科收治的24例采用微创切口联合腹腔镜同期治疗先天性心脏病合并心外畸形患儿(微创联合组)，以及年龄、体重、心脏畸形、手术方式、心功能及麻醉ASA分级相匹配的24例单纯先天性心脏病患儿(单纯先心病组)作为研究对象。统计分析两组患儿术中、术后等临床指标差异性。

结果

微创联合组患儿均成功施行联合手术，术后无明显并发症，两组患儿均成功治愈出院；与单纯先心病组相比，微创联合组患儿麻醉时间及手术时间明显延长，手术费用明显增多，差异有统计学意义(P<0.05)，但体外循环时间、主动脉阻断时间、术中出血量，术后气管插管时间、CICU时间、住院时间、麻醉费用、住院费用等指标差异无统计学意义(P>0.05)；微创联合组与单纯先心病组术后早期血流动力学指标比较，术后8 h CCE明显高于单纯先心病组(P<0.05)，其余术后各时点CCE差异无统计学意义；两组CI、dp/dt、Glu、Lac、IS指标在术后0、4、8、12、16、20、24 h差异均无统计学意义(P>0.05)。

结论

微创切口联合腹腔镜同期治疗先天性心脏病合并非心脏畸形安全可行，同时具有切口美观的优点，值得临床推广。

关键词: 先天性心脏病, 心外畸形, 同期手术, 微创切口
Objective

To investigate the safety and feasibility of combined minimally invasive incision and laparoscopy for the treatment of congenital heart disease (CHD) with extracardiac anomalies.

Methods

Twenty-four cases of CHD with extracardiac anomalies treated with combined minimally invasive incision and laparoscopy (minimally invasive group) and 24 cases of simple CHD matched for age, weight, cardiac malformation, surgical approach, cardiac function, and ASA classification (simple CHD group) were selected from Nov. 2015 to Apr. 2023 at the Affiliated Children′s Hospital of Capital Institute of Pediatrics. Clinical indicators during and after surgery were statistically analyzed for differences between the two groups of patients.

Results

Minimally invasive combined surgeries were successfully performed on the group of patients, and there were no significant postoperative complications. Both groups of patients were successfully cured and discharged from the hospital. The anesthesia time and operation time in the minimally invasive group were significantly prolonged compared to the simple CHD group, with statistical significance (P<0.05). However, there were no significant differences in extracorporeal circulation time, aortic cross-clamp time, intraoperative blood loss, postoperative endotracheal intubation time, CICU time, length of hospital stay, anesthesia costs, surgical costs, and hospitalization costs (P>0.05). In the comparison of early postoperative hemodynamic indicators between the minimally invasive group and the simple CHD group, CCE at 8 hours postoperatively was significantly higher in the minimally invasive group (P<0.05), while there were no statistically significant differences in CCE at other time points. There were no significant differences in CI, dp/dt, Glu, Lac, and IS indicators between the two groups at 0, 4, 8, 12, 16, 20, and 24 hours postoperatively (P>0.05).

Conclusion

Combined minimally invasive incision and laparoscopy for the treatment of CHD with extracardiac anomalies is safe and feasible, and it has the advantage of aesthetic incisions, which is worthy of clinical promotion.

Key words: Congenital heart disease, Extracardiac anomalies, Simultaneous surgery, Minimally invasive incision
表1 微创联合组与单纯先心病组患儿一般资料对比(±s)
  微创联合组(n＝24) 单纯先心病组(n＝24) χ2 /t值 P值
月龄(月) 41.21±25.81 38.04±20.13 0.474 0.638
男性 91.67% 95.83% 0.336 0.551
身高(cm) 94.21±15.59 98.13±18.96 0.782 0.438
体重(kg) 14.67±4.06 16.04±6.75 0.855 0.398
心功能分级     1.155 0.766
1 33.33% 37.50%    
2 66.67% 58.33%    
3 0 4.17%    
ASA分级     2.455 0.117
Ⅱ 0 16.67%    
Ⅲ 100% 83.33%    
表2 同期手术组与分期手术组临床及住院指标[±s，M(P25，P75)]
项目 微创联合组(n＝24) 单纯先心病组(n＝24) t/Z值 P值
麻醉时间(h) 3.96±0.70 3.43±0.76 －2.530 0.015
手术时间(h) 3.27±0.67 2.56±0.68 －3.631 0.001
体外循环(h) 49.79±26.70 47.88±26.97 －0.247 0.806
阻断时间(h) 26.17±18.0 24.71±15.95 －0.297 0.768
气管插管(h) 4.2(3.6，6) 5(4，8.5) －1.052 0.293
术中出血(ml) 20(20，20) 20(16.3，20) －0.763 0.446
CICU时间(d) 1(1，1) 1(1，1) －1.439 0.150
住院时间(d) 11.42±4.44 10.33±2.88 －1.002 0.322
住院费用(元) 50075(45376，53328) 46906(41307，51039) －1.711 0.087
手术费用(元) 4686(3848，11068) 2876(2468，9348) －2.250 0.024
麻醉费用(元) 429(360，1223) 374(360，886) －1.903 0.057
图1 微创联合组与单纯先心病组术后24 h各时点CCE变化
图2 联合组与单纯先心病组术后24 h各时点CI变化
图3 微创联合组与单纯先心病组术后24 h各时点dp/dt变化
图4 微创联合组与单纯先心病组术后24 h各时点Glu变化
图5 微创联合组与单纯先心病组术后24 h各时点Lac变化
图6 微创联合组与单纯先心病组术后24 h各时点IS变化
1
杨涛，王芳，朱玉蓉，等. 中国儿童先天性心脏病流行病学特征研究进展 [J]. 心脏杂志，2024, 36(1): 106-111.
2
张伟，屈昕芃，王双兴，等. 先天性心脏病并非心脏畸形的研究进展 [J]. 中华实用儿科临床杂志，2019, 34(24): 1917-1920.
3
魏丹，张辉，李龙，等. 先天性心脏病合并其他系统畸形联合同期矫治手术的效果分析 [J]. 心肺血管病杂志，2017, 36(8): 678-681.
4
Wang J, Wang Q, Pan Z. Simultaneous repair of congenital heart defects and pectus excavatum in young children[J]. Pediatr Surg Int, 2018, 34(3)：269-275.
5
Nguyen UH, Nguyen TLT, Kotani Y, et al. Doubly committed ventricular septal defect: Is it safe to perform surgical closure through the pulmonary trunk approached by right vertical axillary thoracotomy？[J]. JTCVS Open, 2023, 15：368-373.
6
张伟，屈昕芃，秦广宁，等. 先天性心脏病并非心脏畸形同期联合手术疗效分析[J]. 中华实用儿科临床杂志，2020，35(20)：1571-1576.
7
Yang G, Deng X, Yang Y, et al. Simultaneous operative repair of pectus excavatum and concurrent congenital heart defects[J]. Interact Cardiovasc Thorac Surg, 2019, 28(5)：783-788.
8
Cao Y, Peng Q, Su J. Experience of repair ventricular septal defect with left superior vena cava through right axillary thoracotomy[J]. Heart Surg Forum, 2022, 25(1)：E097-E100.
9
ⅰstar H, Sevuk U. Minimally invasive cardiac surgery in low-resource settings: right vertical infra-axillary mini-thoracotomy without peripheral cannulation - the first 100 cases[J]. Eur Rev Med Pharmacol Sci, 2023, 27(13)：6247-6255.
10
Lo Rito M, Brindicci YCM, Moscatiello M, et al. Minimally invasive surgery for simple congenital heart defects: preserving aesthetics without jeopardizing patient safety[J]. J Cardiovasc Dev Dis, 2023, 10(11)：452.
11
Said SM, Greathouse KC, McCarthy CM, et al. Safety and efficacy of right axillary thoracotomy for repair of congenital heart defects in children[J]. World J Pediatr Congenit Heart Surg, 2023, 14(1)：47-54.
12
Silva Lda F, Silva JP, Turquetto AL, et al. Horizontal right axillary minithoracotomy: aesthetic and effective option for atrial and ventricular septal defect repair in infants and toddlers[J]. Rev Bras Cir Cardiovasc, 2014, 29(2)：123-130.
13
阳广贤，易立文，向金星，等. 儿童先天性漏斗胸合并先天性心脏病的同期手术治疗策略探讨 [J]. 中华小儿外科杂志，2020, 41(2): 150-155.
14
Dodge-Khatami J, Dodge-Khatami A. Advantages of a mini right axillary thoracotomy for congenital heart defect repair in children[J]. Cardiol Young, 2022, 32(2)：276-281.
15
Chu DI, Tan JM, Mattei P, et al. Outcomes of laparoscopic and open surgery in children with and without congenital heart disease[J]. J Pediatr Surg, 2018, 53(10)：1980-1988.
16
冯勇，夏仁鹏，邹婵娟，等. 完全腹腔镜与传统腹腔镜手术治疗婴儿胆总管囊肿的对比研究 [J/CD]. 中华腔镜外科杂志(电子版), 2024, 17(2): 90-94.
17
曾纪晓，梁子建. 单孔腹腔镜手术在儿童普通外科中的应用与展望 [J/CD]. 中华腔镜外科杂志(电子版), 2024, 17(2): 65-69.
18
McHoney M, Corizia L, Eaton S, et al Carbon dioxide elimination during laparoscopy in children is age dependent[J]. J Pediatr Surg, 2003, 38(1)：105-110.
19
Gillory LA, Megison ML, Harmon CM, et al Laparoscopic surgery in children with congenital heart disease[J]. J Pediatr Surg, 2012, 47(6)：1084-1088.
20
Çiçek MÇ，Kaynak Y, Günseren KÖ，et al. The effects of laparoscopic urologic surgery on cardiac functions: a pulse wave velocity study[J]. Turk J Urol, 2020, 46(1)：1-5.
21
胡一，张道珍. 低压力气腹对先天性心脏病患儿短小腹腔镜手术后心功能的影响 [J]. 临床医学，2016, 36(3): 1-2.
22
Herrick NL, Bickler S, Maus T, et al. Laparoscopic surgery requiring abdominal insufflation in patients with congenital heart disease[J]. J Cardiothorac Vasc Anesth, 2022, 36(3)：707-712.
23
吴永杰，屈昕芃，王双兴，等 小儿先天性心脏病合并腹股沟斜疝同期联合手术的临床分析[J/CD]. 中华疝和腹壁外科杂志(电子版), 2020, 14(6): 589-592.
24
侯宇希，韩丁，欧阳川. 用压力记录分析法分析完全肺静脉异位引流患儿手术中血流动力学变化 [J]. 心肺血管病杂志，2018, 37(9): 857-861.
25
张辉，艾长顺，魏丹，等. 婴儿室间隔缺损合并肺炎心衰的术前集束化治疗 [J]. 中华胸心血管外科杂志，2018, 34(4): 237-239.
26
Briganti A, Evangelista F, Centonze P, et al. A preliminary study evaluating cardiac output measurement using Pressure Recording Analytical Method (PRAM) in anaesthetized dogs[J]. BMC Vet Res, 2018, 14(1)：72.
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