高原地区经右腋下小直切口心内直视手术的早期疗效

Early outcome of open heart surgery through subaxillary vertical thoracotomy at high altitude

目的：评价高原地区采用经右腋下小直切口施行先天性心脏间隔缺损修补术的早期效果。方法：选择2001年6月至 2001年9月在海拔 3700 m手术治疗的先天性心脏间隔缺损合并肺动脉高压患者18例，根据手术径路，将患者随机分成两组：右腋下切口组（n=9），采用右腋下小直切口；正中切口组（n=9），采用传统的胸骨正中切口。观察右腋下小直切口对关胸时间、术后辅助呼吸时间、24h胸腔引流液量以及监护病房停留时间和术后住院时间的影响。结要：均无早期死亡。右腋下切口组体外循环结束后关胸所需时间、监护病房停留时间以及术后住院时间均显著短于正中切口组（P＜0. 05）；右腋下切口组术后24h的胸腔引流液量亦显著少于正中切口组（P＜0．05）；术后拔除气管插管的时间两组间无显著差异（P＞0．05）；出院时经超声心动图检查均未发现残余漏。结论：高原地区采用经右腋下小直切口，施行先天性心脏间隔缺损心内直视修补手术，能避免或减少胸骨正中切口的弊端，明显缩短术后的愈合周期，而且切口隐蔽、美观，可取得满意的早期疗效。

Objective: To explore the effects of open repair for congenital heart septal defect through subaxillary verticalthoracotomy at high altitude. Methods: Eighteen congenital heart defect patients with pulmonary hypertension, including 9cases of secundum atrial septal defect (ASD) and 9 ventricular septal defect (VSD), underwent operative repair under car-diopulmonary (CPB) at an altitude of 3 700 m, and were randomized into subaxillary vertical thoracotomy group (S. T.group, n= 9) and midline sternotomy group (M. S. group, n=9). There were 10 Tibetan and 8 Tibetan-born Hans with amean age of 8. 9 years (2-13 years). All patients received surgical repair under moderate hemodi1utional and tepid CPB withbeating heart. ASD repair was performed in 9 patients and VSD repair in 9 including 7 cases of direct closure and 2 of patchrepair. Modified De Vega's tricuspid annuloplasty was done in 11 patients. Results: There was no operative death. The timeof chest closure, the ICU stay and the postoperative hospital stay were significantly shorter and the chest drainage in the firstpostoperative 24 h was statistically 1ower in S. T. group (P<0. 05), whereas the extubation time were not significantly dif-ferent between the 2 groups (P>0.05). Neither residual VSD nor ASD has been documented by echocardiographic evaluationat the discharge. Conclusion: Surgical repair of congenital heart septal defects under tepid CPB with beating heart throughsubaxillary vertical thoracotomy has a satisfying early clinical outcome at the high altitude due to the faster recovery with abetter cosmetic surgical incision.