胸骨正中小切口在先天性心脏病手术中的应用

Inferior Partial Median Sternotomy for Correction in Congenital Heart Diseases

目的：总结胸骨正中下段小切口行先天性心脏病手术的应用体会。方法：采用胸骨正中下段小切口,自胸骨角下方2～3cm至剑突,长6～10cm。正中锯开胸骨至第2肋间,横断右半侧胸骨。在全麻、体外循环下行先天性心脏病手术43例,年龄4～26岁,平均12.4岁。其中室间隔缺损33例,房间隔缺损6例,法洛四联症2例,主动脉窦瘤破裂1例,部分型房室管畸形1例。结果：全组无手术死亡,术后纵隔引流少,无并发症出现。结论：胸骨正中下段小切口适于大多数先天性心脏病手术矫治,具有创伤小,美观的优点,可以完成大部分心内直视手术。

Objective ：To review the experiences of correction for congenital heart defect through inferior partial median sternotomy. Method： Between May 2002 and Aug. 2006,43 cases of congential heart diseases underwent inferion partial median sternotomy for correction. The age ranged from 4 years to 26 years with a mean of 12.4years. A 6 ～10cm in the patient midline incision was made from the third rib to the base of xiphoid process. Cardiopulmonary bypass was established as usual. Abnormalities included ventricular septal defect in 33 cases, atrial septal defect in 6, tetralogy of Fallot in 2, rupture of aortic sinus aneurysm and par- tial endocardial cushions defect in 1 case, respectively. Result：There were neither perioperative complications nor hospital death. Aortic cross - clamp time and postoperative average mechanical ventilation time was 42.3 ± 10.6 minutes and 10.8 ± 6.2 hours, respectively. The median blood loss 183.4 ± 39.6ml and the incision was 6cm to 10cm. Conclusion：Inferior partial median stemotomy is a safe ahemative for correction of congenital heart defect. It is cosmetically acceptable and less traumatic.