婴儿先天性心脏病右腋下小切口心脏直视手术的临床实践

Clinical practice of open heart surgery through a right subaxillary small incision on infants with congenital heart disease

目的：总结婴儿先天性心脏病在右腋下小切口进行心脏直视手术的临床经验。方法2010年5月至2014年3月我院对77例1岁以下先天性心脏病患者采用右腋下小切口施行心脏直视手术，男31例，女46例，年龄4～12个月，平均（8.1±2.0）个月。均在全麻体外循环停跳下手术，行室间隔缺损修补术23例（同期右心室流出道疏通术8例），房间隔缺损修补术32例，同期室间隔缺损修补术加房间隔缺损修补术10例，完全肺静脉异位引流矫治术3例，部分心内膜垫缺损修补术9例。结果全组均顺利完成手术，主动脉阻断时间8～35 min[（18.5±10.4）min]，体外循环时间18～66 min[（35.0±16.5）min]，术后呼吸机辅助时间2～10 h[（5.1±2.4h）]。术后胸腔引流量10～70 ml[（35.0±17.7） ml]。体外循环预充血量0～200 ml[（77.7±20.5）ml]，其中49例未输血，输血率为36.4％，住ICU时间1～3 d[（1.2±0.5）d]，住院7～10 d[（8.3±1.6）d]，均痊愈出院，无残余漏，无并发症，无死亡，术后6个月随访无异常。结论右腋下小切口应用于婴儿先天性心脏病心脏直视手术安全可靠，切口小而且隐蔽。

Objective To introduce the experience of open heart surgery through a right subaxillary small incision on infants with congenital heart disease .Methods From May 2010 to March 2014 ,77 patients under one year of age with congenital heart disease who underwent open heart operation by right subaxillary small incision were enrolled in this study .There were 31 male and 46 female,aged from 4 months to 12 months,with an average age of （8.1 ±2.0 ） months.All operations were performed in the general anesthesia and cardiopulmonary bypass with aortic cross-clamping,ventricular septal defect repair in 23 cases（8 cases of right ventricular outflow tract surgery ）, atrial septal defect repair in 32 cases,ventricular septal defect repair with atrial septal defect repair in 10 cases,total anomalous pulmonary venous connection treatment in 3 cases,partial atrioventricular septal defect repair in 9 cases. Results The operations were successfully performed with good exposure , aortic cross clamp time was 8-35 min [（18.5 ±10.4）min],cardiopulmonary bypass time was 18-66 min [（35.0 ±16.5）min],postoperative mechanical ventilation time 2-10 h [ （ 5.1 ±2.4 ） h ] , postoperative bleeding volume was 10-70 ml [ （ 35.0 ±17.7 ） ml ] , the volume of blood transfusion was 0-200 ml [ （ 77.7 ±20.5 ） ml ] , of which 49 cases without blood transfusion （63.6%）,ICU stay was 1-3 d [（1.2 ±0.5）d]hospital stay was 7-10 d [（8.3 ±1.6）d].There were no operative death and complications .Postoperative course was uneventful .All the patients had no symptom and enjoyed a full＆amp;nbsp;range of physical activities for a follow-up of 6 months.Conclusion The right subaxillary small incision for the cardiac operation in congenital heart disease infants under one year of age is safe and reliable .