胸骨正中小切口在心脏手术中的应用  

Expierence of application of lower median ministernotomy in heart surgery

作　　者：白树堂[1] 林巍[1] 符洪犊[1] 李美霞[1] 

机构地区：[1]海口市人民医院心胸外科,海南海口570208

出　　处：《海南医学》2010年第6期13-15,共3页Hainan Medical Journal

基　　金：海口市重点科技计划项目(编号:〔2005〕科立-0004)

摘　　要：目的总结56例胸骨下段正中小切口心脏手术的体会。方法2005年12月-2008年8月共进行胸骨下段小切口心脏手术56例,包括先天性心脏病手术37例,瓣膜手术17例,心脏粘液瘤切除2例。术中未使用任何特殊的手术器械。结果全组无早晚期死亡,体外循环时间18-58min,平均41min;主动脉阻断时间0-42min,平均36min。27例完成心脏不停跳手术,心脏停跳手术的29例中,开放循环后25例自动复跳,4例电击一次复跳。术后气管插管时间2-5h,平均3.2h。术后胸腔引流量120-350ml,平均280ml;术后42例需要输血,输血量(400±100)ml,平均200ml。全组术后ICU时间1d,术后恢复良好,切口甲级愈合。术后住院7-11d,平均8d。47例获随访,随访率83.6%,随访时间6-48个月,症状均明显改善。结论胸骨下段正中小切口心脏手术创伤小,安全可靠;皮肤切口小,美观;无须特殊器械,操作简单易行,在特定病例中可获得良好的手术效果。Objective To review the experience of 56 cases with cardiac operations through a lower median ministernotomy. Methods 56 cardiac operations via a lower median ministernotomy route were carried out from December 2005 to August 2008, involving 37 operations for congenital heart diseases, 17 valve operations, 2 other operations, with no special instruments required. Results No patients died within the hospitalization period. Offpump operations were employed in 27 patients, while in the remaining 29 patients the cardiopulmonary bypass time was 18 -58 min （mean =41 min） and the aortic CROSS -clamp time was 0 -42 rain（ mean =36min）. The time of postoperative tracheal intubation was 2 -5h （mean = 3.2 h）, and the postoperative chest drainage was 120 -350 ml（mean =280 ml）. Blood transfusion were required after surgery in 42 patients with an amount of （400 ＋ 100） ml. The postoperative ICU and hospital stay were ld and 7 -lld （mean = 8 d）, respectively. A followup for 8 -48 months in 47 patients was conducted. No dead cases were noted and symptoms were significantly improved. Conclusion In properly selected cases, heart operations through a lower median ministernotomy provides many advantages including mini - invasion, high reliability, excellent cosmetic results, simple performance, and good surgical outcomes.

关 键 词：心脏手术 胸骨 小切口 

分 类 号：R654.2[医药卫生—外科学]