胸部小切口微创手术治疗先天性心脏病的早期结果

Early-term results of minithoracotomy incision for the repair of congenital cardiac defects

目的总结右或左前外胸部小切口治疗先天性心脏病的早期结果。方法2010年4月到2012年12月，63例先天性心脏病患者采用右或左前外胸部小切口的方法完成手术，其中男22例，女41例；年龄30．6岁。手术包括房间隔缺损修补术38例，室间隔缺损修补术19例，部分心内膜垫缺损矫治术3例，肺静脉异位引流矫治术1例，Ebstein畸形矫治术1例，主动脉窦瘤破裂修补术1例。结果手术切口长度2．5～7．0cm，平均（4．76±0．95）cm。全组无中转大切口开胸手术，无手术死亡。体外循环36～209min，平均（76．38±29．97）min；主动脉阻断0～138min，平均（33．49±31．50）min。气管插管2～37h，平均（10．53±6．13）h；监护室停留4～42h，平均（14．93±7．65）h；术后住院2～14天，平均（5．42±1．98）天。9例输血，54例未输血。随访1～32个月，平均（13．75±8．91）个月，超声心动图提示所有患者无残余漏，一般情况佳。结论胸部小切口微创治疗先天性心脏病安全、可行。

Objective To evaluated the early-term results of the right or left anterolateral minithoracotomy used for the repair of various congenital heart defects. Methods All the patients with congenital heart defects who were operated with this incision between April 2010 and December 2012 were reviewed. There were 63 patients （41 females, 22 males） underwent openheart surgery through right or left anterolateral minithoracotomy. Ages ranged from 12 to 69 years, mean （30.63 ± 1 1. 74） years. Corrected defects included atrial septal defect（ASD） closure in 38 , closure of ventricular septal defect（VSD） in 19, correction of partial atrioventrieular canal defect （PECD） in 3, correction of partial anomalous pulmonary venous connection（ PAPVC ）in l, correction of Ebstein＇s anomalyin 1, and repair of ruptured aneurysm of the sinus of Valsalva in 1. Results In all patients, length of incision was （4.76±0.95 ） cm. There was no early or late death . No patient required conversion to full sternotomy. The median CPB and aortic clamp times were （76.38 ± 29.97 ） and （33.49 ± 31.50） minutes, respectively. Median intubatiou time was （10.53 ± 6.13 ） hours. Median duration of intensive care and postoperative hospital stay was （14.93 ± 7.65 ） hours and （5.42 ± 1. 98 ） days, respectively. Only 9 patients （ 14.3 % ） received blood transfusion. Follow-up echo showed no residual defect. All palients have gratifying cosmetic results and are in excellent condition after a median follow-up of （ 13.75 ± 8.91 ） months. Conclusion The small anterolateral thoracotomy in congenital cardiac surgery is a safe and feasible approach ,and with a excellent cosmetic results.