微创小切口心脏手术与常规切口的对比研究  

A study of comparison between small incision of cardiac operation and regular incision

作　　者：张德奎[1] 刘宏[1] 单清华[1] 

机构地区：[1]青岛市第八人民医院心胸外科青岛市心胸外科研究所,266100

出　　处：《中国医师进修杂志（外科版）》2009年第7期20-23,共4页Chinese Journal of Postgraduates of Medicine

基　　金：青岛市科技局资助科研课题（2004Kzd-47）

摘　　要：目的探讨心脏手术不同人路的创伤、疗效和预后，以指导临床。方法对41例动脉导管未闭患者行左腋下小切口（A组）；46例房间隔缺损、室间隔缺损、法洛三联症患者行右腋下小切口（C组）；49例瓣膜置换、室间隔缺损、房间隔缺损、法洛四联症、左心房黏液瘤患者行胸骨下段小切口（D组）；与常规左胸后外侧切口42例（B组）及胸骨正中切口77例（E组）进行对比观察。结果（1）A组手术时间（38±13）min、出血量（17±12）ml、住院天数（6-I-2）d，与B组[分别为（64±14）min、（200±100）ml、（11±3）d]比较差异均有统计学意义（P〈0．01）。（2）C组体外循环时间（39±8）min、出血量（150±50）ml、住院天数（8±3）d，与E组[分别为（68±8）min、（700±300）ml、（12±4）d]比较差异均有统计学意义（P〈0．01或〈0．05）。D组出血量、引流量与E组比较差异有统计学意义（P〈0．05）。结论左腋下小切口、右腋下小切口、胸骨下段小切口手术具有切口小、出血少、创伤小、疼痛轻、胸廓稳定、恢复快、住院天数少、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 was apphed to 41 patients with ductus arteriosus（A group） ;right axiUary minithoracotomy was apphed to 46 patients with atrial septal defect （ASD）, ventricular septal defect （VSD）, triple-symptom complex of Fallot（C group） ; 49 patients with replacement of valvular heart, VSD, ASD,tetralogy of Fallot, left atrial myxoma were operated in substernal segment minithoracotomy （D group）. The comparison between above groups and the regular left chest posterolateral operation on 42 patients （B group） and the sternal median operation on 77 patients （E group）was carried out. Results （1） A group had such advantages as the operation time, hemorrhage volume, hospital day, compared with B group [ （38± 13 ） min vs （64 ± 14） min, （ 17 ± 12） ml vs （200 ± 100） ml, （6 ± 2） d vs （ 11 ± 3 ） d, respectively ] （P 〈 0.01 ）. （2） There were difference in extra corporeal circulation time, hemorrhage volume and hospital day between C group and E group [ （39 ± 8 ） min vs （68 ± 8） min, （150 ± 150） ml vs （700 ± 300） ml, （8 ± 3） d vs （12 ± 4） d, respectively] （P〈 0.01 or 〈 0.05）. There were difference in hemorrhage volume, fluence between D group and E group （P 〈 0.05）. Conclusion Small incision, slight trauma, less hemorrhage, shght ache, quick recovery, concealed incision and so on are characteristic of the left subaxillary minithoracotomy for hgation of ductus arteriosus, the right subaxillary minithoracotomy for opening heart operation with heart heating and the substernal segment minithoracotomy for opening heart operation with extra corporeal circulation.

关 键 词：心脏手术 左腋下小切口 右腋下小切口 胸骨下段小切口 

分 类 号：R654.1[医药卫生—外科学] R734.2[医药卫生—临床医学]