右胸小切口心内直视下心脏不停跳手术临床研究

Intracardiac Repair Under Vision Through Right Mini-thoracotomy Approach Without Heart Arrest

目的报告经右胸小切口心内直视下心脏不停跳修补房间隔缺损(ASD),室间隔缺损(VSD)18例。方法取左侧卧位,右侧抬高45～60°,取右腋下或右前外侧小切口,长约6～8cm,经第四肋间进胸,在常温体外循环(CPB)心脏不停跳下直视修补ASD7例,VSD9例,ASD+VSD2例。结果本组无死亡,手术时间[(120.56±15.54)vs(180.43±33.13)],CPB时间[(33.8±13.2vs(74.74±35.83)],术后呼吸机辅助时间[(5.83±0.69)vs(9±1.74)],胸腔引流量[(163.56±43.95)vs(234.78±48.98)],术后住院天数[(7.17±0.69)vs(10.91±1.72)],均明显减少,与同期一组23例经前正中切口进胸相比较有显著性差异(P<0.01)。结论右胸小切口心脏不停跳心内直视下修补ASD、VSD是一种安全、可靠、疗效好的方法之一。

Objective To summarize the experience of intraeardiac repair ASD, VSD under direct vision through mini - thoracotomy without heart arrest（ 18 cases）. Methods Total 7 cases of ASD, 9 cases of VSD, 2 cases ASD combined with VSD were repaired under ordinary temperature cardiopulmonary bypass（CPB）. The incisions were under right armpits with 6 -8cm long. Patients position, left lateral position, the elevated angle of the other side was 45 - 60°. Results There was no operativedeath. The time of operation[（120.56 ± 15.54） vs （180.43 ±33.13）1, CPB[（33.8 ± 13.2） vs （74.74 ±35.83）], ventilation [ （ 5. 83 ±0.69） vs [（9 ± 1.74）], volume of drainage [ （165.56 ±43.95） vs （243.78 ±48.98） ] ,hospital stay [ （7.17 ±0.69） vs （10. 91 ± 1.72） ] were significantly less. There was a significant differicenee compared with those 23 cases through mediam sternotomy at the same period（ P 〈0.01）. Conclusion Intracardiac rapair ASD , VSD under direct vision through right mini - thoracotomy without heart arrest is a safe and effective technigue.