右前外小切口在心脏直视手术中的应用

Clinical application of cosmetic invision for open heart surgery

目的研究右前外小切口在心脏直视手术中的应用。方法选定42例，男13例，女29例，年龄2～38岁（20．1±7．3），体重4～63kg（平均17．2±9．4）。单纯二尖瓣病变7例，二尖瓣合并三尖瓣病变1例，房间隔缺损（ASD）22例，室间隔缺损（VSD）11例，部分房室通道（PAV）1例。施行单纯人工二尖瓣置换8例，二尖瓣置换合并三尖瓣成形1例，房间隔缺损和室间隔缺损直接缝合12例，补片对例，二尖瓣成形合并房间隔缺损补片1例。结果术后无1例死亡，胸腔引流管置放时间1～1，5天，与常规正中切口相同，引流量为130．5ml±24．3ml，明显少于同期相同例数的正中切口的引流量（210．4ml±40．9ml）（P＜0．05），平均术后留院时间为6．2天±1．0天，明显较正中切口的10．2天±2．3天缩短（p＜0．05）。结论手术创伤小，恢复快，住院时间短，费用少，疼痛轻，且美容效果好，不破坏胸廓原有的支架结构，减少术后呼吸功能的改变，同时避免术后形成鸡胸，减少感染的机会。

Objective To discuss the clinical use of cosmetic incision for open heart surgery. Methods Rightanterolateral thoracotomy was performed on 42 patients, and there were 8 cases of rehumatic heart diseases and34 cases of congenital heart diseases, 7 of mitral valve stenosis (MS) /With insufficient (MI), 1 MS with tricus-pid valve insufficient (TI),22 atrial septal defects (ASD), 11 ventricular septal defects (VSD), 1 part atrioven-tricular canal (PAVC),8 cases received mitral valves replacement (MVR), 1 MVR with tricupid valve plasty(DeVega). 12 pure suture of ASD and VSD, 21 path reparation, 1 mitral valve plasty with interatrial patch. Re-sults There were no severe operative complications, and no operative death. All procedures were smooth andsatisfactory and the arnounts of thoracic/tube drainage was only 130. 5 ml ± 24. 3 ml. There were no wounds andthoracic cavity infection, and all patients were discharged at 6 .2 d ± 1 .0d postoperatively. Conclusion Thisprocedure was safety, less damage, hemorrhage and postoperative complication. The recovery was quick and theaverage length of stay in hospital was shout.