右胸外侧小切口与胸骨正中切口心内直视手术的对比研究  

Comparison study of right lateral minithoracotomy with median sternotomy for correction of cardiac defects

作　　者：王士忠[1] 刘立群[1] 隽兆东[1] 刘效波[1] 赵晓华[1] 张勇[1] 

机构地区：[1]山东潍坊潍坊医学院附属医院心胸外科,261031

出　　处：《中国分子心脏病学杂志》2010年第1期48-50,共3页Molecular Cardiology of China

摘　　要：目的探讨右胸外侧小切口行心内直视手术的疗效及治疗体会。方法回顾分析1999年6月～2009年3月期间,常见先心病患者行经右胸外侧小切口手术97例,与同期行正中切口进行同类先心病手术129例的治疗效果进行比较研究,对比研究两组主动脉阻断时间、体外循环时间、术后胸液量、辅助呼吸时间、术后平均住院时间、鸡胸发生率及住院死亡率。结果两组均无住院死亡;主动脉阻断时间、体外循环时间右胸组与正中组比较差异无统计学意义(P>0.05);右胸组与正中组比较:平均总胸腔引流量分别为(223.9±127.1)ml,(379.4±203.9)ml;辅助呼吸时间分别为(248.5±74.4)min,(293.1±122.3)min;术后平均住院时间分别为(7.7±1.2)d,(9.4±0.86)d;鸡胸发生率分别为0%,2.3%(3/129);右胸组均低于正中组(P<0.05)。结论右胸外侧小切口可安全有效地用于部分心内直视手术,与正中切口手术相比,明显缩短术后气管插管及住院时间,切口隐蔽,美观效果好。Objective To evaluate the effect of open-heart surgery through right lateral minithoracotomy and review our experience.Method From Jun.1999-Mar to 2009,97 cases with congenital heart diseases undergoing right lateral minitheracotomy （RLM group）,and 129 cases with congenital heart diseases undergoing median sternotomy （MS group） for correction of cardiac defects were retrospectively analyzed.The aortic cross-clamping time,cardiopulmonary bypass time,average total chest drainage,mechanical ventilation time,mean postoperative hospital stay,pectus carinatum rate,and mortality rate were compared between the two groups.Results There were no death cases in both groups.The cross-clamping time and cardiopulmonary bypass time were not statistically different between the two groups.Compared with MS group：the average total chest drainage,（223.9±127.1）ml vs （379.4±203.9）ml;ventilator-assisted breathing time（248.5±74.4）min vs （293.1±122.3）min;mean postoperative hospital stay （7.7±1.2）d vs （9.4±0.86）d;pectus carinatum rate （0% vs 2.3%）.the results of RLM group were all lower than that of the MS group.Conclusion Right lateral minithoracotomy is safer and better than median sternotomy for correction of cardiac defects;the cosmetic result is better.

关 键 词：心内直视手术 右胸外侧小切口 胸骨正中切口 先天性心脏病 住院时间 对比研究 体外循环时间 胸腔引流 主动脉阻断 室间隔缺损 

分 类 号：R654.2[医药卫生—外科学]