摘要
目的 探讨儿童漏斗胸合并先天性心脏病的同期手术的可行性及手术方法。方法 采用改良Ravitch术式对 11例漏斗胸合并先天性心脏病患儿在常规体外循环手术后施行了同期纠治术,其中男7例,女4例,平均5.4岁;3例继发孔房间隔缺损,6例室间隔缺损,1例法洛四联症,1例动脉导管未闭,术前心功能Ⅰ级4例,Ⅱ级6例,Ⅲ级1例。心内矫治术操作毕,放置有胸腔引流管。结果 所有患儿均平稳地渡过了体外循环。术中主动脉阻断时间、体外循环时间、术后的出血和住院时间与同期类似体外循环手术患儿相比差异无显著性意义(P>0.05),术后循环 18～48 h拔除气管插管、48～72 h拔除胸腔引流管,无术后感染、肺不张等并发症,未见明显二氧化碳潴留。漏斗容积由术前的(26.09±5.54)ml降到了(6.55±1.37)ml。结论 同期手术术后的过程是平稳的,避免了再次手术的麻醉及在胸骨劈开心内直视手术后行漏斗胸纠治所带来的困难,手术结果证明是安全和满意的。
Objective To explore the feasibility of simultaneous surgical repair of pectus excavatum
and congenital heart disease in children. Methods Eleven cases (male 7, female 4) of congenital heart dis-
ease with pectus excavatum were received open-heart correction and modified Ravitch technique simultane-
ously. The mean age was 5.4 years. The diagnosis included secondary atrial septal defect (3), ventricular
septal defect (6) , tetralogy of Fallot (1) and patent ductus arteriosus (1). The sternum was retracted
cephalad and congenital heart disease repair was undertaken in the usual fashion under cardiopulmonary by-
pass. After the intracardiac procedure, the right pleura was opened widely for chest tube drainage. Results
The cardiopulmonary bypass and postoperative course of all patients were stable. As compared with the
aortic cross clamping time, cardiopulmonary bypass time, amount of bleeding and length of hospitalization,
there were no significant difference between simultaneous and routine open-heart operation(P > 0.05).
There were also no postoperative infection, atelectasis and apparent carbon dioxide retention. All patients
were weaned from the ventilator 18 to 48 hours after operation. The chest tubes were removed 48 to 72
hours postoperatively. The postoperative cosmetic appearance was excellent, the funnel bulk of patients de-
creased from (26.09±5.54) ml preoperatively to (6.55±1.37) ml postoperatively. Conclusions The
modified Ravitch technique for simultaneous repair of pectus excavatum associated congenital heart disease
proves to be satisfied, and the postoperative course is uneventful. The advantages of simultaneous repair are
to avoid a second anesthesia and difficulties from previous sternotomy in cardiac surgery.
出处
《中华小儿外科杂志》
CSCD
北大核心
2003年第5期403-405,共3页
Chinese Journal of Pediatric Surgery
