微创技术在成人室间隔缺损修补术中的应用及早期疗效观察

Minimally invasive technique for surgical closure of isolated ventricular septal defects in adult and the early-term results

目的分析19例经胸部小切口修补成人室间隔缺损的临床疗效。方法 2010年7月—2013年1月,共完成各类微创室间隔缺损修补术19例,手术采用右或左前外小切口,女性患者注意保护乳腺组织,预防膈神经损伤。结果本组患者无围术期死亡病例,无明显手术并发症。体外循环时间48～144(81.7±23.2)min,主动脉阻断时间13～74(48.5±13.9)min,切口长度3.0～6.7(5.0±1.0)cm,术后住院时间3～7(4.9±1.1)d。19例患者中未输血17例(89.5%)。出院超声检查无残余漏,无1例胸廓畸形和膈神经损伤。随访患者均对美容效果满意。结论右或左前外小切口微创手术方法治疗成人室间隔缺损是安全可靠的,具有良好的美容效果。

Objective To evaluate our clinical curative resuhs and experiences of use of small anterolateral thoracto- my for closure of isolated ventricular septal defect （VSD） in adult. Methods Between July 2010 and January 2013, 19 pa- tients with ventricular septal defect were treated by open surgery through a small right or left anterolateral thoractomy incision. The mean age was 18 -51 （27.7 ± 8.5） years , 9 males and 10 females, The operation technique were a limited skin inci- sion, protection of mammary gland tissue at female patients, prevention of phrenic nerve damage. Results There were no mortality or significant surgical morbidity. Median eardiopulmonary bypass and cross-clamping times were 48 - 144 （81.7± 23.2 ） mins, 13 - 74 （48.5 ± 13.9） mins, respectively. The mean incision length was 3.0 - 6.7 （ 5.0 ± 1.0 ） cm. All patients were in sinus rhythm. Postoperative hospital stay was 3- 7 （4.9± 1.1 ） days, 17 cases （89.5%） had no blood transfusion. Echocardiography revealed that there were no residual shunts. There is no breast asymmetry and phrenic nerve damage. All pa- tients were satisfied with the cosmetic results during the follow-up. Conclusion Limited right or left anterolateral thoracotomy has a high cosmetic acceptance and was proven to be safe and effective for closure of ventricular septal defects.