右外侧小切口剖胸先天性心脏病矫治术近远期疗效观察

Short-and long-term outcome following congenital heart surgery through a shorter right lateral thoracotomy

目的:调查右外侧小切口先天性心脏病(先心病)矫治术近、远期疗效。方法:1994年10月至2004年4月,所完成的1 386例右外侧小切口先心病矫治术患者为完全组,其中单纯室间隔缺损矫治术患者共488例为处理组,随机抽取同期185例相同年龄正中开胸室间隔缺损修补术患者为对照组。调查以上患者近、远期疗效。近期疗效包括体外循环时间、心肌阻断时间、术后机械通气时间、术后引流液量、术后住院时间、院内死亡情况及并发症发生情况等。远期疗效包括与心脏有关的症状、异常体征及收到随访信1个月以内的超声心动图、胸片及心电图等检查结果。结果:完全组病种包括房间隔缺损、室间隔缺损、法乐氏四联症及部分心内膜垫缺损;共死亡9例(0.65%),并发症发生37例(2.67%)。与对照组相比,处理组在引流液量(106.71 mL vs.146.70 mL)、鸡胸(零例vs.3例)发生等方面具明显优势。结论:右外侧小切口先心病矫治术近、远期疗效不落后于甚至优于正中开胸手术。

Objective：To survey the short- and long-term outcomes for patients following congenital heart surgery through a shorter right lateral thoraeotomy. Methods： The short- and long-term outcomes of 1 386 patients （Total Group） undergone congenital heart surgery through a shorter right lateral thoracotomy between October 1994 and April 2004 are surveyed and the outcomes of 488 patients （Treatment Group） with isolated ventricular septal defects are compared with that of 185 patients （ Control Group） selected randomly with the same defects undergone repair surgery through median sternotomy. Short-term outcomes include cardiopulmo- nary bypass time, arotic crossclamping time, postoperative mechanical ventilation time, amount of drainage, postoperative hospital stay time, in-hospital mortality and morbidity. Symptoms and physical signs related with primary disease and the outcomes of ultrasonic cardiogram, chest film and electrocardiogram are followed up as long-term outcomes. Results： In Total Group, the cardiac defects repaired included atrial septal defects, ven- trieular septal defects, Fallot＇ s Tetralogy and partial endocardial cushion defects. The short- and long-term out- comes are satisfactory with the in-hospital mortality of 9 （0. 65% ） and morbidity of operative complication of 37 （2. 67% ）. Compared with Control Group, Treatment Group＇ s short- and long-term outcomes are more satisfac- tory with less mean amount of drainage [ （ 106. 71±85. 20） ml： （ 146. 70±75.63） mL） J and no incidence of pigeon chest. Conclusion： The short- and long-term outcomes of surgery through a shorter fight lateral thoracot-omy are not less, or even more, satisfactory than that of surgery through median sternotomy for some congenital heart diseases.