先天性心脏病常温不停跳心内矫治术——经正中小切口途径

Intracardiac Operations Performed in Beating Heart for Congenital Heart Diseases Through Ministernotomy

【目的】介绍先天性心脏病在常温不停跳下 ,经胸骨正中小切口行心内直视手术的效果。【方法】 1999年 10月至 2 0 0 0年 9月 ,12例先天性心脏病患者经胸骨下段正中小切口 ,在常温体外循环下 ,不阻断主动脉进行心内矫治术。包括房间隔缺损 (ASD) 7例 ,室间隔缺损 (VAD) 3例 ,房间隔缺损并肺动脉狭窄 (PS) 1例 ,肺动脉狭窄 1例。年龄 4～ 44岁 ,中位数16 1岁。【结果】全组体外循环时间 14～ 48min ,中位数 30min ,7例术后即拔管 ,平均辅助呼吸时间 1 8h ,术中平均用血 140mL ,术后平均输血 110mL ,无低心排综合症 ,心律失常 ,栓塞、肺部和脑部并发症及伤口感染发生。病人恢复快 ,疤痕隐蔽。随访无残余漏。【结论】在常温不停跳下经胸骨下段正中小切口行先天性心脏病心内直视术 ,可提高心肺保护效果 ,减少手术创伤和手术并发症 。

Objective To introduce the result of intracardiac operations performed in normothermic cardiopulmonary bypass without cardioplegia through ministernotomy. Methods Between Oct. 1999 and Sept. 2000, 12 patients with congenital heart diseases underwent this operations, including atrial septal defects (ASD) 7 cases, ventricular septal defects (VSD) 3 cases, pulmonary stenosis (PS) 1 case and ASD combined PS 1 case. The average age was 16 1 years, ranged from 4 to 44 years. Results The cardiopulmonary bypass times ranged from 14 to 48 min (median 30 min). 7 patients got rid of respirator in operative room after palinesthesia. The average assisted mechanical ventilation time was 1 8 h. The average blood transfusion volume was 140 mL during operation and 110 mL postoperation. No low output syndrome, arrhythmia, air embolism, respiratory complication, neurologic complication and wound infection occurred. All patients recovered quickly. No residuary leak was found in the following time. The scar was concealed. Conclusions Use normothermic cardiopulmonary bypass technique without aortic occlusion and through ministernotomy approach, the congenital heart diseases can be operated with good result. It reduces the myocardial and pulmonary injury during operation, decreases complications, make the patients recover more faster and have a good cosmetic appearance.