右腋下小切口心内直视手术的临床应用  

Clinical Application of Open Heart Surgery with Right Subaxillary Cmall Incision

作　　者：刘兵[1] 汪钢[1] 王伟宪[1] 杨学永[1] 王振国[1] 

机构地区：[1]武警医学院附属医院心血管外科,天津300162

出　　处：《中国临床医学》2005年第5期790-792,共3页Chinese Journal of Clinical Medicine

摘　　要：目的：探讨右腋下小切口心内直视手术的可行性和临床应用。方法：2002年7月～2004年7月，采用右腋下小切口(3． 5～8． 0 cm)在体外循环下行心内直视手术92例，年龄10个月～63岁(平均32． 7±12． 4岁)；体重7～67kg(平均36． 3±15． 4kg)。先天性心 脏病患者73例，其中房间隔缺损22例，室间隔缺损35例，肺动脉瓣狭窄6例，法洛四联症5例，二尖瓣关闭不全3例，主动脉瓣关闭 不全2例，合并动脉导管未闭(patent ductus arteriosus，PDA)10例，合并右室流出道狭窄8例，合并三尖瓣关闭不全17例；风湿性心 脏病患者19例，其中二尖瓣狭窄合并关闭不全12例，二尖瓣和主动脉瓣狭窄合并关闭不全6例，主动脉瓣狭窄合并关闭不全1例， 合并三尖瓣关闭不全10例。结果：全组死亡2例，死亡率2． 2%。随访1～20个月，90例患者恢复良好，切口瘕痕小且隐蔽，无胸骨畸 形。结论：右腋下小切口心内直视手术可行，适用于大多数心内直视手术；其操作简便、创伤小、显露好、恢复快、瘢痕小、切口美观，是 安全的治疗方式。Objective：To investigate the feasibility and application of open heart surgery with right subaxillary small incision. Methods： From July 2002 to July 2004, we adopted right subaxillary small incision open heart surgery under cardiopulmonary bypass in 92 cases. The average age and average body weight were 32.7 ＋ 12. 4 years （10 months to 63 years） and 36. 3 ＋ 15.4 kg（7 to 67 kg）, respectively. Of 92 patients, 73 with congenital heart disease, included atrial septal defect in 22 patients, ventricular septal defect in 35, pulmonary stenosis in 6, tetralogy of Fallot in 5, mitral insufficiency in 3 and aortic insufficiency in 2. Concomitant cardiac anomaly, included patent ductus arteriosus in 10 patients, tricuspid insufficiency in 17 and right ventricle outflow tract constriction in 8. 19 patients with rheumatic heart disease, included mitral stenosis and insufficiency in 12, aortic stenosis and insufficiency in 1, mitral and aortic stenosis and insufficiency in 6. Concomitant tricuspid insufficiency in 10 patients. Results：The length of skin incision ranged from 3. 5 to 8. 0cm. The mortality rate was 2. 2% （2/92）. 90 patients survived after surgery. They were followed up for 1 to 20 months. They recovered smoothly and no severe complications occurred. No sternal deformity was found and their incision were slightly scarred. Conclusion： Right subaxillary small incision open heart surgery is feasible, it is characterized by excellent visualization, minimal invasion, rapid recovery, good cosmetic results and safety.

关 键 词：小切口 心内直视手术 外科治疗 

分 类 号：R654.2[医药卫生—外科学]