右外侧小切口剖胸矫治小儿先天性心脏病1972例  

Correction of cardiac defects through the right mini-lateral-thoracotomy

作　　者：苏俊武[1,2,3] 凌雁[1,2,3] 李晓锋[1,2,3] 范祥明[1,2,3] 李志强[1,2,3] 李磊[1,2,3] 吴永涛[1,2,3] 朱耀斌[1,2,3] 贺彦[1,2,3] 程沛[1,2,3] 刘迎龙[1,2,3] 

机构地区：[1]首都医科大学附属北京安贞医院 [2]北京市心肺血管疾病研究所 [3]北京市儿童心血管病中心小儿心脏中心,北京100029

出　　处：《心肺血管病杂志》2012年第4期358-360,共3页Journal of Cardiovascular and Pulmonary Diseases

基　　金：科研基地-科技创新平台-提高重症复杂先心病患儿疗效的基础与临床研究(PXM2011_014226_07_000060);北京市医药产品和技术重大项目培育研究(Z101107050210020);首都市民健康项目培育(Z111100074911001)

摘　　要：目的:总结右外侧小切口剖胸矫治先天性心脏病(先心病)的经验,探讨右外侧切口在先心病的应用与推广。方法 :2002年1月至2011年10月,本手术组经右外侧剖胸小切口完成1 972例小儿先天性心脏畸形矫治。其中男性1 143例,女性829例。年龄平均38.7个月(3～489个月),体质量平均11.6 kg(4.8～69 kg)。主要病种:室间隔缺损、房间隔缺损及法洛四联症等。结果 :术后并发症81例(4.1%):低心排出量综合征(低心排)26例(死亡3例)、严重肺部感染22例(死亡2例)、二次开胸止血8例(死亡1例)、多脏器功能衰竭4例(死亡1例)、一过性脑功能障碍5例、术后残余分流6例(经原切口再次手术1例)、右膈神经麻痹5例(1例膈肌折叠)、术后房室传导阻滞4例(1例置永久起搏器)、乳糜胸2例。随访3～108个月,3例法洛四联症存在残余梗阻26～50 mmHg(1 mmHg=0.133 kPa)观察中,1例二尖瓣成型术后大量反流行二尖瓣置换。结论:先心病可以在右外侧剖胸小切口下完成,该入路安全可靠、创伤小、暴露好并恢复快。Objective： To investigate the value of the right mini-lateral-throacotomy in the correction of congenital heart defects. Methods： From January 2002 to October 2011, 1972 patients underwent the cor- rection of congenital heart defect through the right mini-lateral-throacotomy. Male I 143, female 829. The mean age is 38.7 months. The average weight on operation is 11.6 kg. The defects included ventricle septal defect, atrial septal defect and tetralogy of Fallot etc. Results： The Overall mortality is 0. 35%. Postoperative complica- tions were observed in 81 patients（4. 1% ）. During the follow-up of 3-108 months, 3 patients who underwent TOF correction were found with a residual obstruction of 26-50 mmHg（ 1 mmHg =0. 133 kPa） in the RVOT. A patient received mitral valve replacement because of severe mitral insufficiency after primary correction. Con- clusion： The right mini-lateral-thoracotomy is safe enough to correct the congenital heart defects mentioned a- bove, and meet the aesthetic needs.

关 键 词：先天性心脏病 右外侧小切口 体外循环 

分 类 号：R54[医药卫生—心血管疾病]