右胸外侧小切口小儿先天性心脏畸形矫治术793例体会

Correction of Cardiac Defects through a Shorter Incision of a Right Thoracotomy in Children

目的 :介绍经右胸外侧小切口体外循环下小儿心脏直视手术的经验。 方法 :经右外侧第 4或第 3肋间入胸 ,体外循环下先天性心脏畸形矫治术 793例。修补房间隔缺损 180例 ,室间隔缺损 45 2例 ,室间隔缺损合并房间隔缺损 32例 ,法乐四联症 95例 ,部分心内膜垫缺损 17例 ,二尖瓣关闭不全 7例及其他畸形 10例 ;合并畸形包括 :动脉导管未闭 ,左上腔静脉 ,肺静脉畸形引流 ,右心室流出道狭窄 ,单冠状动脉畸形等。 结果 :本组患儿手术死亡 3例 (死亡率 0 .38% ) ,1例因术后低心输出量综合征 ,1例因严重肺部感染 ,1例因气管插管故障导致器官功能衰竭 ;其它患儿术后并发症少。 结论 :这种切口可安全有效地替代正中剖胸矫治某些小儿常见的心脏畸形 ,它具有损伤小 ,瘢痕隐蔽 ,不破坏胸廓完整性 ,防止术后鸡胸等优点 ,符合微创外科的原则。

Objective:Median sternotomy is a conventional approach for correction of cardiac defects for many years,however,the cosmetic result is poor.Therefore,a right lateral shorter thoracotomy was performed in order to meet the aesthetic requirement. Methods:Seven hundred and ninty three patients underwent correction of congenital cardiac malformations under the cardiopulmonary bypass through right lateral thoracotomy with a short incision through the third or the fourth intercostal space.The average age of them was 3 26±1 74(range,4 months to 7 years)years.The average weight was 13 57±4 44(5—40)kg.Cardiac defects repaired included 180 atrial septal defects(ASD),452 ventricular septal defects(VSD),95 Fallot's Tetralogy,17 partial endocardial cushion defects,32 ASD with coexiting VSD,7 severe mitral regurgitation and 10 other defects.The associated anomalies included:patent ductus arteriosus,left superior vena cava,mitral insufficiency,anomalous pulmonary venous connection,right ventricular outflow tract obstruction,single coronary malformations. Results:Three patients died of operation,including 1 low cardiac output,1 severe pulmonary infection and 1 multi organ failure.The hospital morbidity was minimal. Conclusions:The right thoracotomy incision is a safe and effective alternative to a median sternotomy for correction of cardiac defects.Compared with median sternotomy advantages of this approach include less injury,maintaining the integrity of the bony cage and preventing development of pigeon chest.The scar is small and the cosmetic effect is evident.It is consistent with the idea of minimal invasive surgery.