右外侧小切口剖胸矫治合并心底部畸形的室间隔缺损体会  

Correction of ventricular septal defect combined with malformation in cardiac base through a right thoracotomy

作　　者：范祥明[1,2,3] 陈哲[1,2,3] 李磊[1,2,3] 吴永涛[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364-366,共3页Journal of Cardiovascular and Pulmonary Diseases

基　　金：首都市民健康项目培育(项目编号:Z111100074911001)

摘　　要：目的:总结经右外侧小切口剖胸矫治合并心底部畸形的室间隔缺损(VSD)手术方法及临床疗效。方法:总结经右侧剖胸入路矫治合并简单心底部畸形(动脉导管未闭和/或永存左上腔静脉)的VSD 16例(R组),同期经右侧剖胸入路矫治不合并心底部畸形的VSD 144例(C组),R组在矫治心内畸形的同时,游离结扎动脉导管或游离阻断左上腔静脉。通过对比体外循环时间、主动脉阻断时间、术后机械通气时间、术后引流量、监护室时间以及术后住院时间,观察处理简单心底部畸形对手术的影响和治疗效果。结果:与C组相比较R组体外循环时间[(65.31±17.10)vs.(55.02±15.97)min P<0.05]明显延长,但主动脉阻断时间[(33.44±8.02)vs.(31.40±10.12)min]、术后机械通气时间4.25 hvs.13.08 h、术后引流量88.44 mL vs.89.83 mL、监护室时间2.38 d vs.1.95 d、术后住院时间[(7.88±1.82)vs.(7.88±2.30)d],差异无统计学意义。2组均无死亡及严重并发症,C组有8例患儿术后血痰,1例肺部感染;R组2例血痰。结论:经右外侧小切口剖胸入路矫治合并简单心底部畸形的VSD安全可行。Objective：To summize the experience of correction of ventricular septal defect combined with malformation in cardiac base through a right thoracotomy. Methods： 16 patients aged 3 months to 3 years who had undergone repair of ventricular septal defect through a right thoracotomy combined with malformation in cardiac base were surveyed （ group R） and 144 patients of the same age and weight were surveyed through a right thoracotomy who had not combined with malformation in cardiac base（group C）. The simple malformation in cardiac base include patent ductus arteriosus and/or persistent left superior vena cava. Cardiopulmonary by- pass, aortic cross-clamping and mechanical ventilation time, postoperative drainage, postoperative hospital stay, and intensive care unit stay were measured as evaluation of operation. Results：Compared with group C, cardiopulmonary bypass time were longer [ （65.31±17. 10） versus （55.02±15.97 ） rain, P 〈 0. 05 ], but aortic cross-clamping time [ （ 33.44±8. 02 ） versus （ 31.40±0. 12 ） min ], mechanical ventilation time （14. 25 versus 13.08 hour）, postoperative drainage （88. 44 versus 89. 835 ML）, intensive care unit stay （2. 38 versus 1.95 day）and postoperative hospital stay [ （7.88±1.82） versus （7. 88±2. 30） day] were not significantly different（P 〉 0. 05）. There were no deaths in two groups. There were no serious postoperative complications in both groups. Group C has eight cases of postoperative bloody sputum, one case with pulmonaryinfection. In group R two cases have bloody sputum. Conclusion： Repair of vehicular septal defect with sim- ple malformation in cardiac base through a right thoracotomy is safe and feasible.

关 键 词：右外侧小切口剖胸 心底部畸形 室间隔缺损修补 

分 类 号：R54[医药卫生—心血管疾病]