腋下切口心脏直视手术378例

Subaxillary minithoracotomy open heart surgery in 378 cases

目的探讨胸部腋下切口心脏直视手术效果.方法1995年3月～2004年10月,我院选择性经腋下切口进行心内直视手术378例,其中81例房间隔缺损、32例室间隔缺损、其他病种16例未阻断升主动脉,在心脏跳动下手术,余249例在低温、心脏停跳下完成手术.结果全组手术顺利,手术时间(167±2.0)min,体外循环时间(28.1±16.6)min,右室双腔心术后急性喉水肿气管切开1例,法洛四联症术后低心排综合征死亡1例,脑栓塞1例,切口脂肪液化2例,余术后恢复良好.366例随访2个月～10年,平均5.1年,均能参加正常活动.室间隔缺损残余分流1例,脑栓塞1例完全恢复.结论胸部腋下切口心脏直视手术具有创伤小、恢复快、简便、安全、美容效果好等优点,值得临床推广应用.

Objective To discuss the effectiveness of heart operation through subaxillary minithoracotomy. Methods Subaxillary minithoracotomy heart operation was carried out in 378 cases between March 1995 and October 2004. The operation was performed under beating heart and without the occlusion of the ascending aorta in 81 cases of atrial septal defect, 32 cases of ventricular septal defect, and 16 cases of other diseases. The operation was completed under low temperature and extracorporeal circulation in other 249 cases. Results The operation was accomplished smoothly in all the cases. The operation time was 167 ±2.0 min, and the extracorporeal circulation time was 28. 1 ± 16.6 min. Postoperatively, 1 patient with double - chamber anormaly of the right ventricle was given a tracheotomy because of an acute laryngeal edema, 1 patient with tetralogy of Fallot died of low cardiac output syndrome, 1 patient had a cerebral embolism ,2 patients experienced an incision fat liquefaction ,and the remaining patients recovered uneventfully. A follow- up for 2 months - 10 years（ mean,5. 1 years） in 366 patients revealed a full range of physical activities. One case of ventricular septal defect with residual shunt and 1 case of cerebral embolism were fully recovered. Conclusions Subaxillary minithoracotomy open heart operation has advantages of minimal invasion, quick recovery, simplicity of performance, and good cosmetic results.