右腋下直切口心内直视术治疗598例6月龄以下婴儿先天性心脏病  

Right axillary straight mini-throacotomy in open heart surgery for the infants aged <6 monthes:Analysis on 598 cases

作　　者：余鹏飞 李保军 孟东亮 钟后成 王恒磊 丁旭龙 郑京京 YU Peng-fei;LI Bao-jun;MENG Dong-liang(Dept.of Cardio-surigery No.988 Hospital of PLA,Zhengzhou,Henan 450042,China)

机构地区：[1]解放军第九八八医院心脏外科

出　　处：《实用医药杂志》2019年第6期497-500,共4页Practical Journal of Medicine & Pharmacy

摘　　要：目的探讨右腋下直切口在6个月以下婴儿常见先天性心脏病(先心病)手术中的临床应用效果及可行性。方法回顾性分析2010年1月—2018年2月笔者所在医院598例6个月以下婴儿先心病经右腋下直切口行心内直视术的临床资料,其中男303例(50.7%),女295例(49.3%),年龄45~180 d,体重(5.7±2.2)kg。术前诊断包括:室间隔缺损(VSD)444例(74.2%),房间隔缺损(ASD)45例(7.5%),VSD+ASD 95例(15.9%),VSD合并中重度二尖瓣关闭不全(MR)3例(0.5%),VSD+ASD+中重度MR4例(0.7%),部分肺静脉异位引流(PAPVC)5例(0.8%),部分房室管畸形(PECD)2例(0.35%)。结果围术期死亡4例(0.67%),术后发生肺部感染13例,右肺不张4例,气胸2例,切口局部液化11例,二次开胸止血5例。术后6个月至8年门诊随访476例(79.6%),发现VSD残余分流5例,轻度二尖瓣关闭不全4例,发现右前胸壁较对侧扁平4例,右腋窝下局部胸壁凹陷2例,未发现其他胸廓畸形。结论在6个月以下婴儿常见先心病手术中选择右腋下直切口入路是安全可行的,但需严格选择病例和熟练掌握技术操作方可取得满意临床效果。Objective To analyze clinical outcomes and feasibility of right axillary straight mini-thoracotomy in open heart surgery for infants aged less than 6 months.Methods The 598 infants underwent open heart surgery through right axillary straight mini-thoracotomy from January 2010 to February 2018 in No.153 Hospital(303 males and 295 females;aged from 45 days to 6 months),were retrospectively analysed.Preoperative diagnosis were repectively ventricular septal defect(VSD)in 444 cases,atrial septal defect(ASD)in 45,VSD+ASD in 95,VSD combined severe mitral regurgitation(MR)in 3,VSD+ASD+MR in 4,partial anomalous pulmonary venous connection in 5,partial atrioventricular canal defect in 2.Results There were 6 perioperative deaths(0.67%).Postoperative complications included pneumonia in 13 patients,right atelectasis in 4,right pneumothorax in 2,incision fat liquefaction in 11,and reexploration for bleeding in 5.A total of 476 patients(79.6%)were followed up for 6 months to 8 years after discharge.Residual VSD shunt in 5 patients and mild mitral regurgitation in 4 was found during the follow-up period.The right anterior thoracic wall was found to be relatively lateral and flattened in 4 patients.A local thoracic wall depression was found below the right axilla in 2 patients.No other thoracic deformity was detected.Conclusion It is safe and feasible to select the right axillary straight mini-thoracotomy for infants aged less than 6 months with common congenital heart diseases,but it is necessary to select cases strictly and master technical operation skillfully,just can achieve satisfactory clinical outcome.

关 键 词：右腋下直切口 先天性心脏病 婴儿 

分 类 号：R726[医药卫生—儿科]