Gomparative Analysis Between Total Thoracoscopic And Conventional Thoracotomy In The Treatment Of Atrial Septal Defect

With the innovation of science and technology and the rapid development of medicine,the reduction of surgical trauma,the improvement of postoperative aesthetics,postoperative pain and prevention of complications have been increasingly valued by surgeons and patients.While not affecting the quality of surgery and increasing the aesthetics,minimally invasive surgery is gradually recognized and applied by the majority of surgeons and patients,and the application fields are more and more extensive.Video-assisted thoracoscopic cardiac surgery is gradually accepted in the challenge and recognized by cardiac surgeons,and is widely used in clinical practice.Video-assisted thoracoscopic surgery provides another safe and feasible surgical procedure for patients with congenital atrial septal defect.Total thoracoscopic cardiac surgery has the characteristics of small trauma,aesthetic and rapid healing.However,its operation is difficult,requiring the surgeon to have a solid foundation of traditional cardiac surgery,with certain mirror operation techniques and the ability to handle emergencies.Thoracoscopic cardiac surgery was first used in congenital heart disease surgery,and gradually extended to the field of heart valve formation and replacement,coronary artery bypass grafting under non-extracorporeal circulation,and cardiac myxoma removal.This study focused on total thoracoscopic atrial septal defect repair.From June2017 to October 2018,our hospital’s cardiac surgery has successfully performed 20 cases of atrial septal defect repair under total thoracoscopic extracorporeal circulation.The operation was very successful and achieved good surgical results.A comparative analysis and experience summary were performed in 20 patients who underwent a chest median open thoracic septal defect repair.Purpose:Comprehensive retrospective analysis and comparison of the effects of total thoracoscopic and conventional median sternal open thoracotomy on the postoperative recovery of patients with congenital septal defect,and the feasibility and safety of total thoracoscopic atrial septal defect repair and its advantages and disadvantages.Materials and methods:A retrospective collection of 40 patients with congenital atrial septal defect from June 2017 to October 2018 in the Department of Cardiothoracic Surgery,the First Affiliated Hospital of Nanchang University.According to the different surgical procedures,the observation group（full thoracoscopy）and the control group（conventional surgery）,comparative analysis of operation time（min）,extracorporeal circulation time（min）,ascending aorta blocking time（min）,postoperative ventilator Auxiliary time（h）,intraoperative blood loss（min）,24-hour postoperative pleural fluid drainage（ml）,postoperative ICU stay time（h）,postoperative hospital stay（d）,postoperative first day VAS pain Rating,hospitalization expenses,etc.All data were processed and analyzed by SPSS25.0 software.The data were analyzed by ANOVA and P<0.05 was considered statistically significant.Result:Both the thoracoscopic group and the traditional sternal median thoracotomy group were successfully operated without death.The average age of patients in the total thoracoscopy group was 34.90±13.77 years,and the average body weight was50.58±10.12 kg.The average age of patients in the middle thoracotomy group was37.85±13.17 years old,and the average body weight was 48.82±13.07 kg.There was no significant difference in the basic data between the two groups（P>0.05）.Comparison of intraoperative and postoperative indexes between the thoracoscopic group and the median thoracotomy group: the operation time was [（220.50±42.57min）vs（161.65±21.46min）],and the variance analysis of the two groups was compared,P<0.05;The cycle time was [（107.75±20.54min）vs（47.05±6.27min）],and the variance analysis of the two groups was compared,P<0.05;the ascending aorta blocking time was [（50.15±8.59min）vs（24.80）.±6.40min)],two groups of variance analysis,P <0.05;intensive care time were [（19.92 ± 4.53h）vs（26.56 ± 11.63h）],two groups of variance analysis,P <0.05 The postoperative ventilator assisted time was[（7.36±4.06h）vs [13.43±5.47h],respectively,and the variance analysis of the two groups was compared,P<0.05;the intraoperative blood loss was [（557.14±117.00ml）vs.（866.67±141.42ml）],comparing the two groups of variance analysis,P<0.05;the drainage volume at 24 hours after operation was [（147.50±33.42ml）vs（368.50±215.87ml）],and the two groups were analyzed by variance analysis.P<0.05;postoperative hospital stay was [（6.15±1.14d）vs（7.70±1.42d）],respectively,and the variance analysis of the two groups was compared,P<0.05;the VAS pain score was24 hours after surgery.4.55 ± 0.89)vs（6.80 ± 1.01）],the analysis of variance comparing the two groups,P <0.05;localized liquefaction of incision,wound one patient groups the conventional median sternotomy delayed healing.There were no complications such as air embolism and pneumothorax in the two groups.There were no residual septal shunts in the two groups of patients who underwent echocardiography before discharge.Conclusion:Complete thoracoscopic surgery for atrial septal defect is more effective than traditional median thoracotomy.Although the cost of hospitalization is higher than that of the middle thoracotomy in total thoracoscopic surgery,the surgical trauma is small,the intraoperative blood loss is small,and postoperative respiration Machine assisted time,ICU stay time,short hospital stay,quick recovery,low VAS pain score on the first day after surgery,small incision and beautiful appearance,effectively reducing the patient’s physical and mental pain,worthy of clinical promotion.