右侧腋下直切口经三尖瓣途径修补儿童干下室间隔缺损的临床研究  

Using Right Subaxillary Vertical Incision Approach through Tricuspid Valve to Treat Children’s Subarterial Ventricular Septal Defect

作　　者：张本青[1] 刘锐[1] 芮璐 李守军[1] 花中东[1] ZHANG Ben-qing;Liu Rui;Rui Lu;Li Shou-jun;Hua Zhong-dong(Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China.)

机构地区：[1]北京协和医学院,中国医学科学院阜外医院国家心血管病中心,小儿心脏外科中心,北京市100037

出　　处：《中国分子心脏病学杂志》2019年第6期3146-3148,共3页Molecular Cardiology of China

基　　金：国家重点研发计划项目资助(2017YFC1308100)。

摘　　要：目的评价经右侧腋下直切口入路经三尖瓣矫治干下型室间隔缺损的结果,探讨此手术入路的临床可行性与实用性。方法2016年1月至2019年6月,共41例干下型室间隔缺损患者采取经右侧腋下直切口(长度3~4 cm),三尖瓣径路修补缺损。结果全组无死亡,无残余分流,无切口愈合不良及延迟恢复病例。体外循环时间(50.0±11.8)min;主动脉阻断时间(30.5±8.7)min。平均呼吸机辅助时间(2.2±1.6)h、平均ICU停留时间(14.6±6.7)h、住院时间(6.5±1.4)d和胸腔引流(6.8±4.1)ml/kg,全组患者术后右心室流出道压差(5.0±1.6)mmHg。未发现术后心律失常的病例。随访所有患者均通过门诊行超声、胸片、心电图检查,未见残余分流及心律失常,均对伤口的美观性满意。结论右侧腋下直切口经三尖瓣入路修补儿童干下型室间隔缺损是一种安全可行的治疗方法,并保留了肺动脉的完整性。更重要的是,该方法术后伤口的美观性更好。Objective To evaluate the medical feasibility and practicability by assessing the results of using right subaxillary vertical incision(RAVI)approach through tricuspid valve in the treatment of subarterial ventricular septal defect(SAVAD).Methods From January 2016 to June 2019,totally 41 SAVAD patients had been operated RAVI(with an incision length of 3 to 4 cm)approach through tricuspid valve(the Group).Results No cases of death,residual shunt,poorly wound healing and delayed recovery after the operation of the Group.The time for cardiopulmonary bypass and aortic occlusionis(50.0±11.8)min and(30.5±8.7)min respectively for the Group.The average time for ventilator assisting and ICU staying is(2.2±1.6)h and(14.6±6.7)h respectively for the Group.The totally hospital stay time is(6.5±1.4)d with thoracic drainage at an average of(6.8±4.1)ml/kg.All the patients had a right ventricular outflow tract pressure difference at 5.0±1.6mmHg after the operation.No postoperative arrhythmia was noted.All patients were examined by ultrasound,chest radiograph and ECG afterwards,no residual shunt or arrhythmia was noted,and all patients were satisfied with the beauty of the wound.Conclusions RAVI approach is a safe and feasible method to repair children’s SAVAD.RAVI approach has the advantages of preserving the integrity of pulmonary artery.More importantly,the beauty of the wound is better when using RAVI approach.

关 键 词：干下室间隔缺损 右侧腋下直切口 三尖瓣径路 美观性 

分 类 号：R726.5[医药卫生—儿科]