右腋下直小切口心内直视手术的解剖学基础与临床应用

Anatomy and clinical application of the minimal right vertical infra-axillary thoracotomy on intracardiac operation under direct vision

目的探讨右腋下直小切口心内直视手术的解剖学基础及临床应用。方法 2002年1月始至2010年12月我们使用右腋下直小切口行体外循环心脏直视手术,切口上端起自腋中线第2肋间,下端至腋前线第5肋间,切口呈一直线,观测术中显露主动脉、肺动脉、右心及左心范围及效果。结果全部1837例患者中,死亡4例(0.22%),二次开胸止血17例(0.93%),切口愈合不良13例(0.7%)。右腋下小切口与胸骨正中切口相比平均体外循环时间、主动脉阻断时间、手术时间无显著性差异。结论右腋下直小切口心内直视手术显露能达到手术要求,创伤小,出血少,术后恢复快,具有安全性及极好的美容效果。尤其适合于婴幼儿以及年轻女性患者。

Objective To investigate the anatomy and clinical application of the minimal right vertical infra-axillary thoracotomy on intracardiac operation under direct vision.Methods Intracardiac operation through the minimal right vertical infra-axillary thoracotomy was performed on 1837 patients from January 2002 to December 2010.The skin incision began at the third intercostal space along the right midaxillary line extending to the fifth intercostals space along the preaxillary line,which formed a right vertical infra-axillary incision.The exposure result of aortic artery,pulmonary artery and heart were observed.Results Hospital mortality was 0.22% for all 1837 patients（4 cases）.There were no statistical differences in aortic cross-clamp time,cardiopulmonary bypass time,and total operation time between the minimal right vertical infra-axillary thoracotomy and the standard median sternotomy.Conclusions The minimal right vertical infra-axillary thoracotomy can be performed with favorable cosmetic and clinical results,especially suitable to infant and young girls.