右腋下小切口心内直视手术治疗婴幼儿先天性心脏病  

Application of Right Subaxillary Mini-incision Thoracotomy for Congenital Heart Diseases in Infants

作　　者：杨志远[1] 谢周良[1] 裴学良[1] 葛振伟[1] 冯德广[1] 程兆云[1] 

机构地区：[1]河南省人民医院心外科,郑州450003

出　　处：《中国微创外科杂志》2014年第12期1074-1076,共3页Chinese Journal of Minimally Invasive Surgery

基　　金：国家临床重点专科建设项目经费资助(2011)

摘　　要：目的探讨右腋下小切口手术应用于婴幼儿先天性心脏病（先心病）的可行性。方法2010年7月～2012年3月，采用右腋下小切口心内直视手术治疗68例年龄6—15个月婴幼儿先心病。体重6．5～12kg。房间隔缺损27例（其中合并部分型肺静脉异位引流3例，合并肺动脉瓣狭窄1例，合并永存左上腔1例），室间隔缺损37例，（其中合并永存左上腔3例，右室流出道狭窄1例），部分性房室管畸形4例。均在全麻体外循环下经右腋下4—6cm小切口手术修补。结果全组无围术期死亡。体外循环时间（21．6±10．7）min，主动脉阻断时间（16．8±7．5）min；术后渗出胸液量（21．9±9．3）m1，术后呼吸机辅助时间（8．5±2．5）h，术后住院时间（5．4±0．7）d。术后1个月复查无残余分流。结论小切口手术对婴幼儿简单先心病效果确切，术后出血少，美观，隐蔽，不影响胸骨发育，值得推广。Objective To study the experience of right subaxillary mini-incision thoracotomy in the treatment of congenital heart diseases in infants. Methods Sixty-eight infants with congenital heart diseases, aged from 6 to 15 months, were repaired through right subaxillary mini-incision thoracotomy under hypotherimic cardiopulmonary bypass, including 27 eases of atrial septal defect（ASD） , 37 cases of ventricular septal defect（VSD）, and 4 cases of partial atrioventricular canal defet. Associated cardiac anomalies included 3 cases of partial anomalous pulmonary venous connection （PAPVC） , 3 cases of left superior vena cava, and 2 eases of pulmonary stenosis. The length of incision was 4 - 6 em. Results There were no postoperative mortality and residual shunt. The cardiopulmonary time was （21. 6 ± 10. 7 ） minutes and the aortic clamping time was （ 16.8 ± 7. 5 ） minutes. The mean postoperative mechanical ventilation time was （8.5 ± 2.5 ） hours, drainage volume was （21.9 ＋ 9.3 ） ml, and hospital stay was （5.4 ± 0.7） days. Conclusion Right subaxillary mini-incision thoracotomy for infant congenital heart diseases has an excellent curative effect, with advantages of safety, short incision, little blood loss, and no influence on sternum development.

关 键 词：小切口 婴幼儿 先天性心脏病 体外循环 

分 类 号：R726.5[医药卫生—儿科]