| Clinical study(1): Totally thoracoscopic Surgery Versus Median Sternotomy in Pediatric Cardiac septal defect treatmentObjective To examine advantages and disadvantages of totally thoracoscopic Surgery (TTS)and median sternotomy (MS) in pediatric cardiac septal defect disease. Methods From Jul 2004 to Aug 2005,81 patients(TTS group)aged from 1 to 14 were randomly sampled from TTS cases, while 66(MS group)from MS for pediatric cardiac septal defect. The clinical records from two groups were compared on hospital related time, variation of main data of blood routine test, pulmonary function, blood loss and transfusion. Results The aortic clamp time, length of stay, ventilation time and variation of main data of blood routine test in TTS group have no significant difference to those in MS group(P>0.05). Operating times were longer in TTS group than in MS group, while TTS patients had shorter stays in the intensive care unit comparing to MS patients (P<0.01).Preoperative and 3 months postoperative pulmonary function of both teams have no statistically significant difference(P>0.05). Blood transfusion and blood loss have no significant difference between two teams(P >0.05). Conclusion TTS is a safe and reliable method to pediatric cardiac septal defect disease as MS is.Clinical study(2): Totally thoracoscopic surgery in pediatric cardiac disease treatment on different body weightsObjective To study security and characteristic of totally thoracoscopic surgery (TTS) in pediatric cardiac septal defect disease treatment on different body weights. Methods Children weighting 20kg below, 20kg～30kg and 30kg above respectively from TTS cases were grouped as A,B,C, 20 in each group. The clinical records from three groups were compared on time of hospitalization, variation of main data of blood routine test, blood loss and volume of transfusion. Results Length of stay among three groups have no significant difference(P >0.05). The aortic close time , ventilation time and stays in the intensive care unit are shorter in group B and C than in group A(P <0.05). Blood transfusion and blood loss in group A occur fewer than that in group B and C(P <0.05). Main data of blood routine test in group B and C varies fewer than that in group A. There is no statistically significant difference(P >0.05)on the aortic close time , ventilation time and stays in the intensive care unit between group B and C. Conclusion The patients with pediatric cardiac septal defect disease above 20kg body weight are stronger to undergo TTS and have an earlier recovery.Clinical study(3): Anesthetic management for totally thoracoscopic Surgery in Pediatric congenital heart diseases treatmentObjective To investigate anesthetic management in totally thoracoscopic surgery for Pediatric Cardiac septal defect. Methods 147 patients with congenital heart diseases were incorporated in this study. 81 patients(TTS group)aged (8±3)years were randomly sampled from TTS cases, while 66(MS group)from MS aged (7±4)years for pediatric cardiac septal defect. The patients were intubated with single-lumen endobroncheal tube under general anesthesia with moderate hypothermia CPB. The changes in,O2 and CO2 pressure under different tidal volume and operation related time were investigated. Results All operations were successful without critical complication. During anesthesia CO2 pressure increased linearly and O2 pressure changed unclearly with reduction of tidal volume. Operating times were longer in the TTS group than in the MS group (P<0.01), while TTS patients had shorter stays in the intensive care unit than MS patients did (P<0.01). The aortic clamp time, length of stay.and ventilation time in TTS group have no significant difference to those in MS group(P>0.05) Conclusion It is critical during anesthesia management to make sufficient preparation before operation and intensive care during operation, especially changing ventilate methods to expose operation area and strengthening the breathing management.Animal experimental research:An animal experiment for fiberoptic endoscopic surgery on pulmonary valve led by thoracoscopyObjective To investigate an animal experiment for fiberoptic endoscopic surgery on pulmonary valve led by thoracoscopy. Methods Sixty mongrel dogs with satisfactory heart and lung functions were operated with fiberoptic endoscopic surgery by thoracoscopy for relieving pulmonary valve stenosis. These animals were divided into three groups-A,B and C based on operating time. Operative complications in all groups were observed, in addition, operating time, aortic clamp time and cardiopulmonary bypass time of experiment group were recorded as well. Results After much of practice,operating time, aortic clamp time and cardiopulmonary bypass time of group C were notably shorter than those of group A(P <0.05). Fewer operative complications occured in group C than group A(P <0.05). Conclusion Fiberoptic endoscopic surgery on pulmonary valve led by thoracoscopy is feasible on animal. Operating time and skills are related to operative results. |
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