胸骨下段小切口心脏不停跳下室间隔缺损直视修补术

Repair of ventricle septal defect through minimal sternotomy in beating heart

目的 报道心脏不停跳下经胸骨下段小切口修补室间隔缺损的手术方法。方法 A组 :2 4例室间隔缺损患者 ,经胸骨下段小切口修补室间隔缺损 ,在心脏不停跳下进行手术操作。B组 :随机抽取年龄、体重及缺损大小与A组相仿的患者 30例作为对照 ,均经常规胸骨正中劈开切口 ,在心脏停跳下进行修补手术。比较两组的手术时间、体外循环时间、术后机械通气时间、术后引流量及术后住院天数。结果 A组与B组相比 ,切口长度、体外循环时间、术后机械通气时间及术后 2 4h引流量差异有显著性 ,而手术时间及术后住院天数差异无显著性。结论 心脏不停跳下 ,经胸骨下段小切口修补室间隔缺损的手术方法是安全、可靠、美观、恢复快且疼痛小的微创手术方法。

Objective To summarize the practical experience of new minimally invasive and cosmetic approach for ventricle septal defect(VSD) repair in beating heart during CPB in 24 cases. Methods 24 patients underwent mini-sternotomy for VSD repairs. Operations were performed under beating hearts with lowering the patients heads. 30 patients of VSDs treated with unpatch closure operated through sternotomy in open heart without beating(the same age range and as experimental group)were treated as control group. The following indicators were compared between the two groups: length of incision, time of operation, time of CPB, preserving time of trachea intubator, drainage volume within 24 h after operation, hospitalization days. Statistical analysis was performed by using student's t-test. Results Significant difference existed in length of incision, time of CPB, preserving time of trachea intubator and drainage volume between the experimental group and the control group(P<0.05). Other indicators had no significant difference between the two groups. There was no operative or late mortality ,and no mortality directly related to the sternotomy approach with beating heart. Follow-up ranged from 6 to 12 months and in 23 patients, who were free of symptoms without any thoracic deformity. Conclution Mini-sternotomy for VSD repairs in beating heart are new safe, small wounded and cosmetic approach for heart defect repairs. The procedure results in less pain, fewer complications and more rapid recovery.