婴儿右腋下直小切口心内直视术694例临床分析

Clinical outcomes of right axillary straight mini-thoracotomy in open heart surgery in 694 infants

目的：探讨右腋下直小切口在婴儿常见先天性心脏病（先心病）心内直视手术中的应用效果。方法：回顾性分析我院2009年4月至2014年12月,采用右腋下直小切口对694例婴儿先心病行心脏直视手术的临床资料,其中男性349例,女性345例,年龄2~12个月,平均（8.0±3.2）个月,体质量4.0~11.2kg,平均7.5kg。行室间隔缺损（VSD）修补术535例,房间隔缺损（ASD）修补术36例,VSD＋ASD修补术56例,VSD修补术＋二尖瓣成形术（MVP）9例,VSD修补术＋ASD修补术＋二尖瓣成形术（MVP）3例,肺动脉瓣狭窄（PVS）交界切开术15例,ASD修补术＋PVS交界切开术11例,VSD修补术＋PVS交界切开术3例,部分肺静脉异位引流（PAPVC）矫治术9例,部分房室管畸形（PECD）矫治术12例,法洛四联症（TOF）根治术5例。结果：手术死亡10例（1.44%）,术后发生右肺不张4例,右侧气胸2例,肺部感染21例,切口液化19例,Ⅲ°房室传导阻滞1例,脑气栓1例,二次开胸止血5例。术后6个月至1年门诊随访595例（85.7%）,发现VSD残余漏7例,右下肺不张1例,二尖瓣轻度关闭不全4例,二尖瓣中度关闭不全1例。结论：在婴儿常见先心病直视手术中选用右腋下直小切口,只要把握好手术适应症,熟练掌握技术操作要点,均可取得满意临床效果。

Objective：To analyze clinical outcomes of Right axillary straight mini-thoracotomy for open heart surgery of common congenital heart diseases in Infants. Methods：We conducted a retrospective analysis of 694 infants undergoing open heart surgery through right axillary straight mini-thoracotomy from April 2009 to December 2014 in our Hospital. There were 349 males and 345 females with their mean age of （ 8. 0 ± 3.2） months（range,2-12 months）and body weight of （7.5 ±4. 4） kg（rang,4. 0-11.2 kg）. Surgical procedures in- cluded ventricular septal defect （VSD） repair in 535 patients, atrial septal defect （ASD） repair in 36 patients, VSD and ASD repair in 56 patients, VSD repair and mitral valvuloplasty（MVP） in 9 patients, VSD ＋ ASD ＋ MVP repair in 3 patients, valvotomy for pulmonary valve stenosis（PVS） in 15 patients, ASD repair and valvoto- my for PVS in 11 patients, VSD repair and valvotomy for PVS in 3 patients, correction of partial anomalous pul- monary venous connection in 9 patients, and correction of partial atrioventricular canal defect in 12 patients, correction of tetralogy of failot in 5 patients. Results： Ten patients （ 1.44% ） died postoperatively. Postoperative complications included right atelectasis in 4 patients, right pneumothorax in 2 patients, pneumonia in 21 pa- tients,incision fat liquefaction in 19 patients, third-degree atrioventricnlar block in 1 patient, cerebral air embol- ism in 1 patient,and reexploration for bleeding in 5 patients. A total of 595 patients were followed up for 6 to 12 months after discharge. Residual VSD shunt in 7 patients, low right atelectasis in 1 patients,4 patients of mildmitral regurgitation and 1 patients of moderate mild mitral regurgitation was found. Conclusion： Clinical out- comes of fight axillary straight mini-thoracotomy during open heart surgery are satisfactory for infants with common congenital heart diseases, but strict indications and skillful surgical techniques are needed.