胸骨下段小切口行先天性心脏病矫治术116例

Limited Lower Sternotomy for Correction in Congenital Heart Diseases

目的 :介绍胸骨下段小切口行先天性心脏病手术经验体会。 方法 :采用胸骨下段小切口 ,部分劈胸骨 ,在全麻、低温体外循环下行先天性心脏病手术 116例 ,年龄 3个月～ 5 0岁(5 .7± 6 .8)岁 ,其中室间隔缺损 6 6例 ,房间隔缺损 33例 ,法乐四联症 13例 ,肺动脉闭锁、心内膜垫缺损、肺动脉瓣狭窄及冠状静脉窦无顶综合征各 1例。 结果 :全组 1例二次开胸止血 ,无手术并发症和手术死亡。 结论 :先天性心脏病矫治手术可采用胸骨下段小切口、部分劈胸骨入路 ,创伤小、恢复快、美观。

Objective:To review the experiences of correction for congenital heart defect through limited lower sternotomy. Methods:Between August 1998 and August 1999,116 cases of congenital heart diseases underwent limited lower sternotomy for correction.The age ranged from 3 months to 50 years with a mean of 5 7±6 8 years.A 5—7 cm in the children or 9—11 cm in adult midline incision was made from the third rib to the base of xiphoid process.Cardiopulmonary bypass was established as usual.Abnormalities included ventricular septal defect in 66 cases,atrial sepal defect in 33,tetralogy of Fallot in 13,pulmonary atresia,endocardial cushions defect,pulmonary stenosis and unroofed coronary sinus syndrom in 1 case,respectively. Results:There were neither perioperative complications nor hospital death.Aortic cross clamp time,Cardiopulmonary bypass(CPB) time,and postoperative average mechanical ventilation time was 34 7 minutes,61 6 minutes,and 16 1 hours,respectvely.The median blood loss 116 4 ml(range,23 to 590 ml) and the incision was 8 2 cm(range,5 to 11 cm). Conclusion:Limited lower sternotomy is a safe alternative for correction of cogenital heart defect.It is cosmetically acceptable and less traumatic.