Comparison Of Two Different Surgical Approaches For Ligation Of Patent Ductus Arteriosus In Premature Infants

Background and objective This study focuses on the two different approaches of surgical ligation of PDA in premature infants.By comparing the two surgical approaches,the postoperative ICU retention time,ventilator assistance time,hospital stay,and postoperative complications of the two surgical approaches are compared.Analyze the differences and significance between the groups,clarify the safer and more effective surgical approach for premature infants with PDA,and provide reference for clinical application.Methods:Retrospectively collect medical records of children with premature PDA diagnosed in the neonatal intensive care unit and children’s heart care unit of our hospital from 2018.01 to 2021.01.According to the inclusion and exclusion criteria,the eligible children are divided into median thoracotomy according to different surgical methods.Ligation group and left thoracotomy ligation group.Collect the clinical data,intraoperative information and outcome of each child through the electronic medical record system.Among them,the clinical data includes the child’s gestational age,weight,length,rescue history of birth asphyxia,preoperative ventilator assistance time,preoperative transthoracic echocardiography(Transthoracic Echocardiography,TTE),arterial catheter diameter,chest radiograph(lung texture,Heart shadow)and cardiovascular CTA results;intraoperative information includes the child’s operation method,operation duration,intraoperative TTE results and blood loss.The postoperative ventilator assistance time,total ventilator assistance time,ICU retention time,hospital stay,and postoperative complications were recorded as the primary endpoints;postoperative complications were defined as severe postoperative pneumonia,pneumothorax,and hemothorax,Pleural effusion,bronchopulmonary dysplasia,vocal cord paralysis,neonatal retinopathy,severe pneumonia.All data in this study were statistically analyzed using SPSS 23.0 software.Measurement data conforming to the normal distribution are expressed as mean ± standard deviation(±s);measurement data not conforming to the normal distribution are expressed as the median quartile,which is M(Q1,Q3)means;comparison between groups adopts t test or Mann-Whitney U test.Count data was expressed by frequency or composition ratio,and comparison between groups was by chi-square test or Fisher’s exact probability method.p<0.05 indicates that the difference is statistically significant.Results:1.A total of 20 eligible children were included.Among them,10 children were operated with median thoracotomy(median thoracotomy and ligation group),and 10 children were operated by left thoracotomy(left thoracotomy and ligation group).All 20 children underwent ventilator-assisted breathing before operation,and there was no statistically significant difference in the duration of ventilator use before operation.There was no significant difference in gestational age,sex ratio,birth length,weight,birth asphyxia rescue history and PDA diameter between the two groups(p>0.05);2.The observation indexes during and after operation were compared between the two groups of children.There was no significant difference in blood transfusion,operation duration,total length of ventilator use,and total hospital stay(p>0.05).However,compared with the children in the left-side approach surgical ligation group,the children in the median thoracotomy group had significantly shorter postoperative ventilator assistance and neonatal intensive care unit(NICU)residence time than the left side Approach surgery ligation group(p<0.05);3.Among the children in the left-side approach surgical ligation group,8 cases had complications,2cases did not occur,and the total complication rate was 80%;in the median thoracotomy group,5 cases occurred.5 cases did not occur,the total complication rate was 50%,and the difference between the two groups was not statistically significant(p>0.05).However,compared with children in the left-side surgical ligation group,the number of severe pneumonia and pneumothorax in the median thoracotomy group was less(P<0.05).Other complications such as hemothorax,pleural effusion,paralysis of recurrent laryngeal nerve injury,intraventricular hemorrhage,retinopathy,delayed healing,etc.had no significant difference in risk between the two groups of children(p>0.05).Conclusions:1.Compared with the traditional left-side thoracic approach to ligating the PDA of preterm infants,the median sternal approach to ligating the PDA of preterm infants can reduce the use time of the ventilator and the risk of complications such as postoperative pneumothorax and severe pneumonia.2.When ligating the PDA of premature infants with different surgical approaches,there will be complications such as severe retinopathy,intraventricular hemorrhage,and pleural effusion.These inevitable surgical complications require us to take further prevention and Treatment measures what can be avoided.