右腋下小切口心脏不停跳修补先天性房、室间隔缺损  

Repair of Congenital Atrial and Ventricular Septal Defect by Minimal Right Axillary Incision in Beating Heart

作　　者：周亚军[1] 许国安[1] 方向明[1] 徐靖[1] 高栋才[1] 邓武昌[1] 

机构地区：[1]中国人民解放军第九四医院心胸外科,南昌330002

出　　处：《南昌大学学报（医学版）》2011年第10期46-49,共4页Journal of Nanchang University：Medical Sciences

摘　　要：目的探讨右腋下小切口心脏不停跳修补先天性房间隔缺损(atrial septal defect,ASD)、室间隔缺损(ven-tricular septal defect,VSD)的临床疗效。方法 58例先天性ASD、VSD患者(试验组,A组)均采用右腋下小切口联合心脏不停跳技术。手术在浅低温体外循环(CPB)下施行,皮肤切口沿右侧腋下、经第4肋间入胸,距右膈神经前2.0cm纵向切开心包,主动脉及上、下腔静脉插管常规建立CPB,心脏不停跳下修补ASD、VSD。57例先天性ASD、VSD患者(对照组,B组)均行正中切口心脏停跳下修补ASD、VSD。观察2组患者手术切口长度、CPB时间、手术时间及术后呼吸机辅助时间、住院时间、胸瓶引流量、死亡、并发症发生等情况。结果 A组患者手术切口长度、CPB时间、手术时间、术后胸瓶引流量、术后呼吸机辅助时间、住院时间与B组比较差异均有统计学意义(P<0.05或P<0.01),术后病死率及残余分流、肺不张/肺部感染发生率与B组比较差异均无统计学意义(均P>0.05)。结论采用右腋下小切口心脏不停跳技术修补先天性ASD、VSD具有安全、可靠、微创、术后恢复快、切口美观等优点,适用于简单心内直视手术。Objective To explore the curative effect of surgical repair with minimal right axilla- ry incision in beating heart on congenital atrial septal defect （ASD） and ventrieular septal defect （VSD）. Methods Fifty-eight patients with congenital ASD and VSD （group A） received repair with minimal right axillary incision in beating hearts. Operations were performed using cardiopul monary bypass （CPB） technique with mild hypothermia. Skin incisions were made at right armpit and extended into the chest through the fourth intercostal space. The pericardium was opened lon- gitudinally 2 cm anterior to the right phrenic nerve. Aortic cannulation and superior and inferior vena cava cannulation were performed to establish conventional CPB. In addition,57 patients with congenital ASD and VSD （group B） received repair with median sternotomy in non-beating heart. The length of surgical incision, CPB time, operative time, the duration of postoperative mechanical ventilation,the length of hospital stay, chest drainage flow, the mortality and the incidence of complications were observed in both groups. Results There were significant differences in the length of surgical incision, CPB time, operative time, chest drainage flow, the duration of postoper-ative mechanical ventilation and the length of hospital stay between group A and group B（P〈 0.05 or P〈0. 01）. But there were no differences in postoperative mortality and the incidence of residual shunting and atelectasis/pulmonary infection between the two groups（P〈0.05）. Conclu- sion The repair with minimal right axillary incision in beating heart for ASD and VSD is suitable for simple open-heart surgery with advantages of safety, reliability, minimal invasion, rapid postoperative recovery and beautiful incision appearance.

关 键 词：右腋下小切口心脏不停跳 房间隔缺损 先天性 室间隔缺损 先天性 修补术 

分 类 号：R654.2[医药卫生—外科学] R541[医药卫生—临床医学]