摘要
目的介绍经右外侧小切口剖胸体外循环下小儿心脏直视手术的经验。方法１９９４年１０月至１９９７年４月，共完成经右外侧第４或第３肋间进胸，体外循环下先天性心脏畸形矫治术３１９例。患儿年龄３．４４±１．５９岁（５个月～８岁），体重１３．６６±３．９８（６～２６）ｋｇ。修补房间隔缺损８７例（合并左上腔静脉１例，肺动脉瓣狭窄６例，部分肺静脉畸形引流５例），室间隔缺损２００例（合并动脉导管未闭７例，二尖瓣关闭不全７例，左上腔静脉３例，右室流出道狭窄１１例），法乐氏四联症１９例（合并左上腔静脉３例，单冠状动脉畸形１例），部分心内膜垫缺损２例及其他畸形１１例。体外循环时间平均５６．０７±２４．９０（２０～１７６）分，心肌循环阻断３２．９７±２０．３８（６～１４０）分。术后机械通气平均１８．７５±２４．５７（２～１４０．７２）小时，平均住院７．０８±０．６９（７～１７）天。结果全组患儿无手术死亡。结论这种切口可安全有效地替代正中剖胸矫治某些小儿常见的心脏畸形，它具有损伤小，瘢痕隐蔽，不破坏胸廓连续性，防止术后鸡胸等优点，其美观效果优于胸部正中或双乳腺下皮肤切口。
Objective To review the experience of correction of congenital cardiac defects through a right minithoracotomy. Method 319 patients underwent correction of congenital heart malformations through right lateral thoracotomy under cardiopulmonary bypass. The average age was 344±159 years (range, 5 months8 years). The average body weight was 1366～398 kg (range, 6￣26 kg). Cardiac defects repaired included atrial septal defect in 87 patinets (1 patient associated with left superior vena cava (LSVC), 6 pulmonary stenosis, 5 partial anomalous pulmonary venous connection), ventricular septal defect in 200 (7 patients with coexisting patent ductus arteriosus, 7 mitral insufficiency, 3 LSVC, 11 right ventricular outflow tract obstruction ), Fallot′s Tetralogy in 19 (3 patients associated with LSVC, 1 single coronary malformation), partial endocardial cushion defect in 2 and other defects in 11. The mean cardiopulmonary bypass time was 5607±2490 min(range, 20176 min) and the mean aortic crossclamping time was 3297±2038 min(range, 6140min). The average mechanical ventilation time after operation was 1875±2457 hr (range, 214072hr), and the mean postoperative hospital stay was 708±069 days(range, 717 days). Result No operative mortality and severe postoperative complications were noted. Conclusion The right lateral thoracotomy is a safe and effective alternative to a median sternotomy for correction of cardiac defects. Advantages of this approach include less injury, maintaining the continuity and the integrity of the bony thorax, and preventing postoperative pigeon breast.The cosmetic result is superior to that of median sternotomy or bilateral submammary incision.
出处
《中华外科杂志》
CAS
CSCD
北大核心
1998年第7期403-405,共3页
Chinese Journal of Surgery
