右腋下小切口在婴幼儿先天性心脏病中的应用及疗效

Outcomes and Application of Right Subaxillary Small Incision for Congenital Heart Defect in Children

目的：探讨右腋下小切口与胸骨正中切口对婴幼儿常见先天性心脏病的应用。方法选取我院2009年1月～2012年10月的先天性心脏病患者30例，作为此次研究的实验观察对象，其中房间隔缺损（ ASD）8例，室间隔缺损22例。根据手术方式的不同分成实验组（右腋下小切口组，n＝15，男10例，女5例），对照组（胸骨正中切口组，n＝15，男8例，女7例）。结果2组患者均顺利完成手术，术中及术后无死亡病例。实验组清醒时间（3．49±1．83）h、拔管时间（10．81±7．33）h、ICU时间（25．84±11．78）h、体外循环时间（CPB时间）（78．07±23．61）min、阻断时间（51．53±16．16）min，对照组清醒时间（4．07±2．33）h、拔管时间（11．66±8．41）h、ICU时间（30．46±15．55）h、CPB时间（73．07±29．78）min、阻断时间（47．07±26．57）min。2组各变量间比较无统计学差异（ P＞0．05）。虽然数据统计未有显著差异，但实验组与对照组相比，患儿术后清醒时间、呼吸机支持时间较对照组短，同时实验组可能由于小切口术野小、操作较复杂等原因， CPB时间、阻断时间较对照组相对较长。但24h胸腔引流实验组（85．13±19．09）ml，较对照组（116．67±31．47）ml显著减少（P＜0．05）。结论右腋下小切口能取得与胸骨正中切口相同的治疗效果，并且具有创伤小、美观、长期较高的生活品质等优势。

Objective To investigate the application of right subaxillary small incision and median sternotomy in treatment of congenital heart defects .Methods From January 2009 to October 2012 in our hospital ,a total of 30 children with congenital heart diseases undergoing operations were randomized into treat group （right subaxillary small incision,n=15,10 males and 5 females） and control group （median sternotomy,n=15,8 males and 7 females） according to the surgical approach,including 8 cases of ASD and 22 cases of ventricular septal defect .Results The surgical outcomes were successful and no operative deaths or complications occurred .The cardiopulmonary bypass time,aortic cross-clamping time,duration of postoperative mechanical ventilation and postoperative ICU stay in each group were [（78.07 ± 23.61） vs （73.07 ±29.78）min],[（51.53 ±16.16） vs [（47.07 ±26.57）]min,[（10.81 ±7.33） vs （11.66 ±8.41）]h,[（25.84 ± 11.78） vs （30.46 ±15.55）]h.Compared the data between the two groups ,no statistical difference could be found .Although the treat group＇s trend toward a shorter time in duration of postoperative mechanical ventilation and postoperative ICU stay ,a longer time of cardiopulmonary bypass and aortic cross-clamping could be seen in the treat group because of small surgical field and complicated operation .The amount of chest drainage in 24 hours after the operation between the treat group and control group was [（85.13 ±19.09）ml and （116.67 ±31.47）ml, P〈0.05] respectively.There was statistical difference between the two groups .Conclusion Compared to the median sternotomy approach , right subaxillary small incision is minimally invasive and safe enough to cure congenital heart defect with an excellent visualization .