Comparison Of The Clinical Efficacy Of Atrial Septal Defect Repair Surgery Between Small Right-side Chest Incision And Full Thoracoscopy

Research purpose: To investigate the clinical data of two minimally invasive cardiac surgery methods: thoracoscopic beating heart atrial septal defect(ASD)repair and right thoracic small incision for beating heart atrial septal defect repair.The advantages,importance,feasibility and development prospects of thoracoscopic surgery for the development of minimally invasive cardiac surgery technology,and compare the differences and advantages and disadvantages of the two surgical methods.Research method: This study collected data from the Department of Cardiac Surgery,the First Affiliated Hospital of Guangxi Medical University from July 2016 to September 2020.The preoperative clinical symptoms,signs,cardiac color ultrasound,X-ray and other examinations were clearly diagnosed as congenital 57 patients with heart disease-atrial septal defect.According to the different operation methods,it can be divided into two groups for observation(thoracoscopic beating heart atrial septal defect repair)31 cases,patient age(36.36±15.60)years old,weight(55.28±11.78)kg,NYHA cardiac function classification Grade I～III,preoperative transthoracic heart color ultrasonography roughly estimated ASD size(28.32±5.21)mm;control group(right thoracic small incision beating heart atrial septal defect repair)26 cases,patient age(36.17±18.89)years old,Weight(50.11±17.23)kg,NYHA cardiac function classification I～III,preoperative transthoracic heart color ultrasonography roughly estimated ASD size(28.52±8.69)mm;by comparing the size of the surgical incision,the duration of the operation,and the time of cardiopulmonary bypass(CPB),Intraoperative blood transfusion,postoperative complications(pleural effusion,atelectasis,pneumonia,lung abscess,arrhythmia,etc.),postoperative ventilator assistance time,CSICU(cardiothoracic surgery intensive care unit)hospital stay,drainage Tube drainage,postoperative pain score(NRS)and other indicators,using statistical SPSS25.0 software,measurement data are expressed as mean±standard deviation(x±s),using t test;counting data are expressed as rate(%),Using χ2 test.α=0.05 is the inspection level for data analysis.Research results: The comparison of the basic information of the two groups of patients before surgery found that the differences in gender,weight,age,cardiac function classification,and atrial septal defect size were not statistically significant(P>0.05);both groups of patients successfully completed the operation.There were no perioperative deaths.Observation group vs.control group(the following results are all based on this)postoperative comparison index results: surgical incision length: [(4.37±0.93)cm vs(4.21±0.89)cm,P>0.05];operation duration: [(226.09±21.64)min vs(265.34±29.48)min,t=2.282,P=0.027];CPB time: [(61.08±29.64)min vs(63.70±18.62)min,P>0.05];intraoperative blood transfusion(Including all types of blood products):[(216.87±172.43)ml vs(214.45±127.77)ml,P>0.05];Postoperative ventilator assistance time: [(9.05±4.70)h vs(13.06±6.13)h,t= 2.282,P=0.027];CSICU hospital stay: [(24.19±3.68)h vs(25.86±1.06)h,P>0.05];postoperative drainage tube drainage volume: [(146.32±153.68)ml vs(225.37±212.36))ml,t=2.893,P=0.006];Postoperative pain score: [(3.68±1.22)vs(3.66±1.31),P>0.05];Total hospital stay: [(9.84±3.33)d vs(8.66±4.31)d,P>0.05];the incidence of perioperative complications in the two groups after surgery was not statistically significant,that is,P>0.05.The results are as follows: pleural effusion(0 cases vs 2 cases),pneumothorax(2 cases vs.2cases),pneumonia(1 case vs 3 cases),both groups of postoperative incisions were healed by I/nail,there was no secondary operation or poor incision healing,no postoperative atelectasis,arrhythmia,abnormal lower limb activity,phrenic nerve injury,etc.complication.Conclusion: Total thoracoscopic beating atrial septal defect repair is safe and feasible for the treatment of secondary foraminous atrial septum.Compared with the traditional minimally invasive right thoracic small incision method,the total thoracoscopic operation has a shorter operation time,Ventilator assistance time,relatively less intraoperative blood transfusion and postoperative drainage,and the surgical incision has good cosmetic effect,less trauma,quick recovery,light postoperative pain,and low complication rate.It is worthy of further popularization and application It is used in the treatment of atrial septal defect in cardiac surgery.