心脏手术三种小切口与常规切口术式的对比研究  

A Study on and Comparison between Three Operating Ways on Cardiac Surgery and Regular Incision

作　　者：张德奎[1] 单清华[1] 樊健[1] 靳树仁 张书海[1] 孙国林[1] 

机构地区：[1]青岛市第八人民医院,266100

出　　处：《青岛医药卫生》2005年第2期81-83,共3页Qingdao Medical Journal

摘　　要：目的　探讨心脏手术不同入路创伤,疗效,愈后以及临床指导。方法　对40例动脉导管未闭患者行左腋下小切口;41例房间隔缺损,室间隔缺损,法鲁三联症患者行右腋下小切口,心脏不停跳手术;36 例瓣膜置换,法鲁四联症,心脏粘液瘤等患者行胸骨下段小切口;与常规左胸后外侧切口36例及胸骨正中切口43 例,进行对比观察。结果　1.左腋下小切口与常规左胸后外侧切口相比切口大小、手术时间、创伤、痛疼程度、出血量、住院天数、切口愈合程度均有显著性差异。2.右腋下小切口心脏不停跳心内直视手术组与常规胸骨正中切口体外循环心内直视手术组相比:创伤、体外循环时间、出血量、住院天数、疤痕等,有不同程度差异。3.胸骨下段小切口与常规胸骨正中切口组相比:创伤、出血量、住院天数、胸廓畸形、疤痕程度也有差异。结论　1.左腋下小切口行动脉导管未闭结扎术具有切口小、不去肋骨、出血少、不输血、创伤轻、不放胸腔引流管、痛疼轻、恢复快、刀口隐蔽、美观等优点。2.右腋下小切口心脏不停跳心内直视手术,具有切口小、无骨损伤、体外循环时间短、出血少、心脏不停跳、心肌损伤轻、恢复快、切口隐蔽、美观等优点。3.胸骨下段小切口体外循环心内直视手术具有出血少、胸廓稳定、恢复快、切口隐蔽等优点。Objective To guide clinical operation, the invasion, efficacy, convalescence by different operating ways on cardiac surgery were studied.Methods Left axillary minithoracotomy is applied to 40 patients with ductus arteriosus;Right axillary minithoracotomy is applied to 41 patients with atrial septal defect, ventricular septal defect, tetralogy of Fallot under while heart is beating; Thirty-six patients with replacement of valvularheart, tetralogy of Fallot, atrial myxoma were operated in substernal segment minithoracotomy. The Comparison between above groups and the regular left chest posterolateral operation on 36 patients and the breastbone median operation on 43 patients was carried out.Results 1 Operation in left subaxillary minithoracotomy for ligation of patent duetus arteriosus has such advantages (characteristic)as minithoracotomy, less hemorrhage, unnecessary to transfer blood, small invasion, no need to remove ribs ,slight ache, unnecessary to place ducts in thoracic cavity, quick recovery, concealed and better looking incision. 2 There was difference in trauma, extra corporeal circulation time, hemorrhage amount, duration in hospital, scar and so on between right subaxillary minithoracotomy operating group under beating heart and regular breastbone median incision; 3 There was a difference in trauma, hemorrhage amount, duration in hospital, chest malformation, degree of scar between substernal segment minithoracotomy and regular breastbone median incision. Conclusion 1 Minithoracotomy, less hemorrhage, small invasion, no need to transfer blood and excising rib, slight ache, quick recovery, conceal incision and pretty were characteristic of ligation of patent duetus arteriosus which was operated in left subaxillary minithoracotomy; 2 Small incision , short extra corporeal circulation time, less hemorrhage, beating heart, slight injury of cardiac muscle, quick recovery, concealed incision and pretty were characteristic of right subaxillary minithoracotomy for opening heart operation with heart beating

关 键 词：心脏手术 心脏不停跳心内直视手术 体外循环心内直视手术 对比研究 常规切口 胸骨下段小切口 左胸后外侧切口 左腋下小切口 右腋下小切口 胸骨正中切口 动脉导管未闭结扎术 体外循环时间 心脏不停跳手术 术式 住院天数 

分 类 号：R654.2[医药卫生—外科学] R654.1[医药卫生—临床医学]