右腋下小切口在小儿心内直视手术中的应用

Open heart surgery with right subaxillary small incision in children

目的探讨右腋下小切口在小儿心内直视手术中的应用。方法2002年7月～2004年8月,采用右腋下小切口3.5～6.0cm在体外循环下行心内直视手术87例,年龄10个月～12岁,体重7～32kg。其中房间隔缺损22例,室间隔缺损49例,二尖瓣关闭不全5例,肺动脉瓣狭窄6例,法洛四联症5例,合并动脉导管未闭11例,合并三尖瓣关闭不全17例,合并右室流出道狭窄9例。结果全组死亡2例,死亡率2.3%,随访1～20个月,85例患儿恢复良好,切口疤痕小且隐蔽,无胸骨畸形。结论右腋下小切口心内直视手术操作简便,创伤小,显露好,恢复快,瘢痕小,切口美观,适用于大多数小儿心内直视手术,是安全的治疗方式。

[Objective] To investigate the application of open heart surgery with right subaxillary small incision in children. [Methods] From July 2002 to August 2004, we adopted right subaxillary small incision open heart surgery under cardiopulmonary bypass in 87 children. The average age and average body weight were （5.1±2.6） years （10 months to 12 years） and （16.2±6.4） kg （7 to 32 kg） respectively. Cardiac defects repaired included atrial septal defect （ASD） in 22 patients, ventricular septal defect （VSD） in 49, mitral insufficiency in 5, pulmonary stenosis in 6 and tetralogy of Fallot in 5. Concomitant cardiac anomaly, included patent ductus arteriosus in 11 patients, tricuspid insufficiency in 17 and right ventricle outflow tract constriction in 9. [Results] The length of skin incision ranged from 3.5 to 6.0 cm. The mortality was 2.3% （2/87）. 85 children survived after surgery. They were followed up for 1 to 20 months.They recovered smoothly and no severe complications occurred. No sternal deformity was found and their incision were slightly scarred. [Conclusions] Right subaxillary small incision open heart surgery is characterized by excellent visualization, minimal invasion, rapid recovery, good cosmetic results and safety.