胸部小切口心脏直视手术

Open Heart Surgery Through Shorter Incisions of Thoractomy

目的介绍几种体外循环下胸部小切口心脏直视手术的经验。方法 16 1例心脏疾病患者采用右腋下、右前外侧胸、胸骨右侧旁及胸骨下段小切口 ,在体外循环下施行心脏直视手术。病种包括房间隔缺损、室间隔缺损、法乐四联症、二尖瓣狭窄或 /并关闭不全、二尖瓣狭窄并三尖瓣关闭不全及其他畸形 ,包括肺动脉口狭窄、动脉导管未闭及永存左上腔静脉等。结果术后 16 1例患者中 2例 (1.2 % )分别死于消化道溃疡出血及重型肺炎。 1例并发胸骨后出血、 度房室传导阻滞、室间隔缺损修补术后残余分流 ;1例右侧胸腔积液 ,经处理后均康复出院。结论以上各小切口开胸行心脏直视手术是安全、有效的。术野显露好 ,病变矫正满意 ,创伤小 ,并发症少 ,痛苦轻 ,恢复快 ,美观效果亦好。

Objective\ To review the experience of open heart surgery through shorter incisions of thoracotomy Methods\ 161 cases of hear diseases underwent open heart surgery through shorter incisions of right infra axillary thoracotomy, right anterolateral thoracotomy, right parasternal thoracotomy and lower sternotomy separately Cardiac defects concluded 56 cases of atrial septal defects, 69 cases ventricular septal defects(VSD), 8 cases of Fallot's tetralogy, 10 cases of mitral stenosis and (or) mitral insufficiency, 4 cases of stenosis and tricuspid regurgitation, and 14 cases of other defects The associated abnormalities included pulmonary stenosis, patent ducturs arteriosus, left superior vena cava and others Results\ Two patients (1 2 %) died of alimentary canal haemorrhage and severe pneumonia respectively Four cases had perioperative complications, including one case of poststernal bleeding, one III degree atrioventricular block, one remaining defects after VSD repaired and one right hydrothorax All patients recovered after treatment Conclusion\ The above incisions were safe and effective for open heart surgery The provided excellent exposure, pleased deffects corrected, less trauma, less complication, less pain, quick recovery and evident cosmetic effect They can be selected to use in clinical practice by concrete conditions