389例先天性心脏病右外侧小切口剖胸心内直视手术

Right anterolateral thoracotomy for open-heart operation in congenital heart disease,case of 389

目的:总结经右胸外侧小切口体外循环下行先天性心脏病心内直视手术经验。方法:1996年11月至2011年12月,我科室应用右胸小切口完成各类先天性心脏病(先心病)的心内直视手术389例。年龄1.5～57岁,平均13.5岁。体质量7.6～68 kg,平均24.5 kg。手术切口后缘自右腋中线第3肋间处,向前下斜行达锁骨中线第6肋间处做8～12 cm弧形切口,第4肋间入胸。手术方式:房间隔缺损修补157例,室间隔缺损修补150例,部分房室隔缺损矫治8例;右心室流出道疏通术24例;法洛三联症矫治32例,法洛四联症矫治5例以及其他畸形矫治13例。随机选择同期常规手术(胸正中切口)患者100例作为对照。结果:研究组切口长度、手术时间及术后引流量都显著低于对照组;研究组术后呼吸机辅助时间明显低于对照组;术后监护时间各组间差异无统计学意义。研究组手术死亡4例(1.03%),2例死于术后脑栓塞,另外2例死于低心排出量综合征(低心排)。结论:右胸小切口手术入路,可安全有效地行常见先心病的矫治。该技术创伤小、恢复快、美观,并提高了患者的生活质量,值得进一步推广应用。

Objective ：To summarize the experience of right anterolateral thoracotomy in open-heart op- eration for congenital heart diseases. Methods ： From Nov. 1996 to Dec 2011, 389 patients with congenital heart diseases underwent open-heart operation by right anterolateral thoracotomy in our department. The average age of them was （ 13.5±11.8） year, （ 1.5-57 ） years. The average weight was （ 24. 5±18.7 ） kg （7. 6 -68） kg. Cardiac defects repaired included 157 atrial septal defect s（ASD）, 150 ventricular septal defects （VSD）, 8 partial endocardial cushion defects, 5 Fallot Is Tetralogy, 32 stenosis of right ventricular outflow tract, 32 ASD with coexiting stenosis of right ventricular outflow tract and 13 other defects. 100 cases of conven- tional open-heart operation （median sternotomy） were selected randomly as the control group. Results： The op- eration time, length of incision, postoperative drainage volume and postoperative mechanical ventilation time of patients underwent right anterolateral thoracotomy were significantly lower than those of control group cases. There was no statistical differences in postoperative care time between all groups. Four patients died of opera- tion, including 2 low cardiac output and 2 cerebral embolism. The hospital morbidity and mortality was mini- mal. Conclusion： The minimally invasive right thoraeotomy incision is a safe and effective alternative to a me- dian sternotomy for correction of some congenital heart diseases. Compared with median sternotomy, advantages of this approach include less injury, maintaining the integrity of the bony cage. The scar is small and the cos- metic effect is evident. The right thoracotomy is a kind of simple, efficient, economic minimally invasive tech-nique.