微创左腋下直切口治疗动脉导管未闭56例

Treatment of Patent Ductus Arteriosus through Left Vertical Subaxillary Minithoracotomy (56 Patients Report)

目的 总结经左腋下直切口治疗动脉导管未闭的疗效.方法 采用微创左腋下直切口治疗先天性动脉导管未闭56例,切口自左侧腋中线第2肋间至第5肋间,长约5～8 cm,经第3或第4肋间进胸,显露并游离动脉导管, 降低动脉收缩压至60～80 mmHg. 行导管直接结扎40例, 导管切断缝合16例.结果 56例手术均顺利完成,术中显露良好,术后无残余分流;术后无声音嘶哑,无导管破裂,无手术死亡.50例随访3个月～6年,生活质量良好,心功能正常,无导管再通及假性动脉瘤形成. 结论微创左腋下直切口治疗动脉导管未闭具有损伤小、切口隐蔽、出血少、恢复快等优点,手术效果满意.

Objective To summarize the clinical treatment outcomes of patent ductus arteriosus（PDA） through left vertical subaxillary minithoracotomy.Methods 56 patients with congenital PDA were surgically treated through the left vertical subaxillary minithoracotomy.40 patients were treated by directly ligation of patent ductus arteriosus and 16 patients by division and suture after the systolic blood pressure was decreased to 60～80 mmHg.Results All the operations were successfully accomplished and there was no operative death.The operative exposure was good and there was no residual shunt and hoarseness after operation.During the 3 months to 6 years follow-up in 50 cases,there was no recanalized PDA pseudoaneurysm formation.Conclusion It is recommended of the left vertical subaxillary minithoracotomy incision for the treatment of PDA with advantages of mini-trauma,less pain and less bleeding.