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[Abstract] Objective: To investigate the feasibility and safety of thoracoscopic cardiac surgery incision protective sleeve in clinical application. Methods: a thoracoscopic incision protective sleeve was designed. 125 patients who underwent thoracoscopic atrial septal defect repair and mitral valve replacement in our hospital from October 2009 to March 2010 were randomly divided into two groups. The observation group used incision protective sleeve during operation, and the control group did not use incision protective sleeve during operation. The intraoperative bleeding, postoperative drainage, operation time The lens wiping times and incision healing were compared. Results: after using the incision protective sleeve, the amount of intraoperative bleeding and postoperative drainage decreased, the number of lens wiping decreased significantly, and the operation time was significantly shortened in the observation group. Compared with the control group, the difference was significant (P < 0.05). Conclusion: thoracoscopic cardiac surgery incision protective sleeve can reduce the amount of bleeding, shorten the operation time, have good safety, simple manufacture and low price.
Video-assisted thoracoscopic heart surgery is to put special surgical instruments through a small incision on the chest wall under the observation of the video-assisted thoracoscopic image acquisition screen. It has the advantages of small trauma, rapid recovery, few complications, small scars and beautiful postoperative appearance. It has become one of the important means of minimally invasive treatment of heart diseases. With the continuous updating and R &amp; D of new surgical instruments and consumables, the surgical indications have been further expanded. In order to facilitate the operation and reduce complications, we made a self-made thoracoscopic incision protective sleeve for cardiac surgery. This paper aims to explore the feasibility and safety of thoracoscopic cardiac surgery incision protective sleeve in clinical application.
1、 Data and methods:
1. General data: 125 patients who underwent thoracoscopic atrial septal defect repair and mitral valve replacement in our hospital from October 2009 to March 2010 were randomly divided into observation group and control group. 62 cases in the observation group, aged 5 ~ 60 years, were treated with thoracoscopic cardiac incision protective sleeve, including 41 cases of atrial septal defect repair and 21 cases of mitral valve replacement; 63 cases in the control group, aged 4 ~ 62 years, did not use incision protective sleeve during operation, including 44 cases of atrial septal defect repair and 19 cases of mitral valve replacement. Exclusion criteria: (1) patients whose intraoperative exploration was inconsistent with the original surgical diagnosis; (2) Patients who need to extend the surgical incision due to changes in their condition during operation. There was no significant difference in age, sex and disease type between the two groups (P > 0.05).
2. Method:
2.1 construction and fabrication of thoracoscopic cardiac surgery incision protective sleeve the incision protective sleeve includes inner ring (about 5cm in diameter), outer ring (about 6cm in diameter) and latex sleeve. When making, select a disposable No. 6 latex glove, cut off the upper end at the root of the thumb, leaving only the wrist to form a latex sleeve; Select the infusion connecting pipe with thick pipe wall, cut off two sections of hose, the length of which is about 16cm and 19cm respectively, and connect the two ends of the hose with plastic connecting columns to form an inner ring and an outer ring. Wrap the latex sleeve with the inner ring and the outer ring for several circles respectively. The distance between the inner ring and the outer ring can be adjusted by the number of wrapping circles. Because the latex sleeve has certain elasticity and ductility, it can meet the needs of different incision subcutaneous tissue thickness. In addition, the inner ring and outer ring are closed ring bodies composed of hose and connecting column, and their sizes can be changed by mutual adjustment of hose and connecting column.
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2.2 operation method: after opening the surgical incision, the operator shall first shape the inner ring into an ellipse by hand, align the front end of the ellipse with the incision, insert it close to the incision wall, and then press and push the rear end of the ellipse to make the inner ring expand slowly through the incision. The inner ring is reset and inserted into the incision. The inner and outer rings are separated inside and outside the incision, and then the operator shall according to the thickness of the patient's chest wall, Self adjust the natural latex sleeve to the appropriate length, that is, adjust the distance between the inner ring and the outer ring by wrapping the outer ring inward or uncoiling the latex sleeve outward, adjust the outer ring to make the pipe close to the notch wall and expand the notch. Take out the protective sleeve: the operator extends his fingertip into the incision protective sleeve, hooks a part of the inner ring, turns the inner ring and takes it out from the incision. 2.3 outcome measures: (1) intraoperative bleeding; (2) Postoperative drainage; (3) Operation time; (4) Number of lens wiping; (5) Number of non nail healing incisions. The follow-up time was 3 months.
3. Statistical methods: SPSS 11.0 statistical software was used for analysis, and X-ray was used for comparison between the two groups ² There was significant difference (P < 0.05).
2、 Results: compared with the control group, the use of incision protective sleeve in the observation group effectively reduced the amount of intraoperative bleeding and postoperative drainage. At the same time, it also significantly reduced the number of lens wiping (P < 0.05) and effectively shortened the operation time. Although there was no significant difference in the number of non-nail healing incisions between the two groups (P > 0.05), the above indexes in the observation group were lower than those in the control group (Table 1). Table 1 Comparison of clinical indexes between the two groups（ χ ± s) group n intraoperative bleeding volume (ML) postoperative drainage volume (ML) operation time (min) times of lens wiping (Times) number of non nail healing incisions (cases) observation group 62 80.94 ± 27.45 153.6 ± 35.32 121.81 ± 23.82 7.71 0 control group 63 103.97 ± 28.57 32.4 ± 46.13 142.46 ± 30.45 12.33 2 P 0.003 0.046 0.01 0.002
3、 Discussion: thoracoscopic cardiac surgery is an important part of minimally invasive cardiac surgery. Because the surgical instruments directly enter the body through the surgical incision for surgical operation, it is easy to damage the adjacent incision tissue, while the instruments and lenses repeatedly enter the friction incision, it is easy to cause the subcutaneous tissue to fall off, resulting in the foreign bodies such as small fat particles to fall off and enter the heart, which brings danger to the patients, It is also easy to cause the injury of cutting I = I, affect the wound healing and infection. At the same time, the bleeding of the incision is easy to pollute the lens, blur the surgical field of vision, affect the accuracy of the surgical operation, and increase the number of lens wiping. Excessive traction during the operation will also cause postoperative wound pain and blood stasis.
The inner and outer rings of the incision protective sleeve have the functions of elastic deformation and elastic recovery, and can smoothly enter and exit the incision. The double rings are embedded inside and outside the incision. The elastic natural latex sleeve constitutes the access channel for the instrument. Its function is to expand the irregular wound, expand the surgical field of vision, facilitate the entry and operation of surgical instruments, and increase the operability of thoracoscopic heart surgery. The uniform tension of the incision can reduce tissue damage, reduce incision infection, reduce the amount of intraoperative bleeding, reduce the number of lens wiping during the operation, shorten the operation time, and effectively prevent foreign bodies from entering the heart. Most of the existing incision protective sleeves at home and abroad are suitable for laparoscopic surgery, and the size of the snap ring can not be adjusted. Therefore, the application range of the incision is small. However, the pipe connecting the two snap rings cannot be expanded and extended, so it is inconvenient to adjust the expansion and contraction according to the thickness of the incision tissue. In the actual operation process, it will affect the positioning stability of the snap ring protective sleeve entering the incision, thus affecting the surgical field of vision. Due to the requirements of preparation materials and production technology, the existing incision protective sleeve has high cost and high price, which increases the treatment cost to patients, so it can not be popularized in thoracoscopic surgery. The self-made incision protective sleeve of our department can adjust the size of the inner and outer rings according to the size of the incision, without making products of different sizes and models according to the size of the incision, which expands the scope of application of the incision. In addition, the distance between the inner ring and the outer ring of the natural latex sleeve can be adjusted according to the thickness of the subcutaneous tissue of the incision, which also strengthens the fit between the protective sleeve and the incision.
The patients who used incision protective sleeve were followed up for 3 months, and no intraoperative and postoperative infection complications were found, which showed that the new incision protective sleeve had good clinical safety and was worthy of promotion.