右腋下小切口与胸骨正中切口治疗儿童简单先天性心脏病的对比研究  

Comparative clinical study of right subaxillary vertical minithoracotomy vs median sternotomy for treatment of uncomplicated congenital heart defects in children

作　　者：严曼榕[1] 李福平[1] 李志平[1] 沈诚[1] 胡义杰[1] 陈建明[1] 钟前进[1] 

机构地区：[1]第三军医大学大坪医院野战外科研究所心血管外科,重庆400042

出　　处：《检验医学与临床》2015年第8期1095-1096,共2页Laboratory Medicine and Clinic

摘　　要：目的通过对比右腋下小切口与胸骨正中切口治疗儿童简单先天性心脏病,探讨和评价两种手术路径的优劣,以期进一步提高临床治疗效果。方法采用回顾性分析的方法 ,分析该科收治的心脏直视手术患者临床资料,依据手术治疗方式不同分为右腋下小切口组和胸骨正中切口组,对其手术结果及主要并发症进行比较。结果两组患者在手术时间、体外循环时间等方面进行比较,差异无统计学意义(P>0.05);在术后引流量方面,胸骨正中切口组术后引流量明显多于右腋下小切口组;胸骨正中切口组术后呼吸机辅助通气时间、监护室滞留时间、术后住院时间均大于右腋下小切口组,差异有统计学意义(P<0.05)。结论经右腋下小切口矫治简单先天性心脏病安全、有效,与胸骨正中切口相比,创伤小,出血少,瘢痕隐蔽,不破坏胸廓的骨性连续性,防止手术后发生鸡胸,美观效果好于胸骨正中切口,值得临床推广运用。Objective The study by comparing the right subaxillary vertical minithoracotomy and median sternotomy incision,to explore the pros and cons and evaluate the surgical path,in order to further improve clinical outcomes.Methods Retrospective assessment of clinical parameters and procedural outcomes in patients who underwent cardiac operation under direct vision,108 patients through the right subaxillary vertical minithoracotomy under cardiopulmonary bypass and 108 patients through the midline sternotomy.Results Two groups of patients in the operative time,CPB time and postoperative hospital stay was no significant difference（P〉0.05）.The volume of postoperative drainage in postoperative drainage sternotomy group significantly is more than those in the right axillary incision group.postoperative ventilator assisted ventilation time、intensive care unit residence time and postoperative hospital stay in median sternotomy incision group are more than those in right axillary incision group,there are a statistically significant（P〈0.05）.Conclusion The right subaxillary vertical minithoracotomy is a safe and effective alter native to a median sternotomy for correction of cardiac defects.Advantages of this approach include less injury,less bleeding,maintaining the continuity and the integrity of the bony thorax,and preventing postoperative pigeon breast.The cosmetic result is superior to that of median sternotomy.

关 键 词：右腋下 正中切口 儿童 简单先天性心脏病 

分 类 号：R654.2[医药卫生—外科学]