小儿右胸切口体外循环心内直视手术体会  

Experience in cardiac corrective operation through right thoracotomy during cardiopulmonary bypass in children

作　　者：舒涛[1] 杨楚敦[1] 皮明安[1] 舒龙[1] 林红[1] 江泽熙[1] 

机构地区：[1]武汉市儿童医院心胸外科,430015

出　　处：《临床外科杂志》2004年第3期170-171,共2页Journal of Clinical Surgery

摘　　要：目的　总结经右胸切口行小儿体外循环心内直视手术的体会。方法　 1999年 4月至 2 0 0 1年 8月 ,10 6例先天性心脏病患儿经右胸切口行心内直视根治术 ,年龄 ( 4 .3± 2 .8)岁 ( 4个月～ 14岁 ) ,体重 ( 15 .4± 6.4)kg( 6～ 3 8kg)。病种 :室间隔缺损 68例 ,2例合并二尖瓣返流 ,肺动脉高压 7例。房间隔缺损 3 7例 ,TOF1例。平均总转流时间为 ( 5 3 .9± 2 1)min ,心脏停跳时间 ( 19.2± 15 )min。平均用血量 ( 4 0 0± 5 0 )ml。术后平均呼吸机辅助时间 ( 7.11± 13 )h ,胸引流量 ( 80 .5±5 3 )ml。结果　全组治愈。术后右上或中叶肺不张 9例 ,胸腔少量积液 3例。随访时间 1个月至 2年 ,患儿情况良好。结论　本方法的优点是 :( 1)操作较简便 ,容易掌握 ,尤适用于 2～ 5岁 ,单纯房、室间隔缺损的修补 ;( 2 )手术创伤小 ,术后康复快 ;( 3 )切口美观 ,瘢痕小 ;( 4 )胸引量明显少于正中切口 。Objective To review the experience of correction of congenital cardiac defects through a right thoracotomy.Methods 106 patients underwent correction of congenital heart malformations through right lateral thoracotomy under cardiopulmonary bypass.The average age and average body weight were 4.3±2.8 years (4 months to 14 years) and 15.4±6.4 kg (6 to 38 kg) respectively.Cardiac defects repaired included atrial septal defect (ASD) in 37 patients, ventricular septal defect (VSD) in 68,pulmonary hypertension in 7,mitral insufficiency in 2 and Fallot's tetralogy in 1.The mean cardiopulmonary bypass time was 53.9±21 min and the mean aortic cross clamping time was 19.2±15 min respectively.The average mechanical ventilation time after operation was 7.11±13 h.Results No operative mortality and severe post-operative complications were noted.Conclusion The right lateral thoacotomy 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 bonythorax, and preventing post-operative pigeon breast.The cosmetic result is superior to that of median sternotomy in treatment of ordinary congenital heart defects such as ASD,VSD and so on.

关 键 词：小儿 先天性心脏病 右胸切口根治术 

分 类 号：R726.5[医药卫生—儿科]