胸骨下段切口心脏不停跳技术在儿童先心病心内直视手术中的应用

Application of lower sternal incision with on-pump beating heart intracardiac procedures in children of congenital heart disease

目的：探讨胸骨下段切口心脏不停跳技术在儿童先天性心脏病心内直视手术中的应用价值。方法选择78例0～12岁先天性心脏病患儿，应用胸骨下段切口心脏不停跳技术实施手术。患儿均采用胸骨下段小切口，锯开胸骨至第三胸肋关节，常规建立体外循环，术中不阻断主动脉，同时采取左心房左心室引流和综合序贯排气技术，改善手术野显露，完善术中排气。随机选择本院同期所做的另外80例病种接近、年龄相当患儿作为对照组，采取胸骨正中切口心脏停跳下手术治疗。结果患儿均顺利完成手术，无一例死亡，无空气栓塞、残余分流及完全性房室传导阻滞等严重并发症发生。手术时间和体外循环时间与对照组比较，差异无统计学意义。皮肤切口长度较对照组平均缩短4.2 cm，小切口组术后胸骨畸形的发生率明显较低。结论胸骨下段切口结合心脏不停跳技术可以减轻手术创伤，简化操作，提高手术疗效，是一种安全、有效、美观的手术方式。

Objetive To explore the application of lower sternal incision with on-pump beating heart int-racardiac procedures for congenital heart disease （CHD）. Methods A total of 78 CHD cases aged under 12 years underwent lower sternal incision under beating heart condition.Sternum was sawed open to the third ster-nocostal joint through a small incision in lower sternum.Cardiopulmonary bypass （CPB）was performed without aortic cross-clamping.Simultaneous left atrium and ventricle suction and integrating sequential de-airing was established for improving the exposure of surgical field and intraoperative de-airing.We also randomly selected 80 patients with similar disease and age as controls.The controls underwent middle sternal incision surgery with arresting heart.Results All patients were successfully operated without mortality or such severe complications as air embolism,residual shunt and complete atrioventricular block.Operative and CPB time in experimental group was not significantly different from that in control group.The length of skin incision in experimental group was shortened by 4.2 cm compared to that in control group.The incidence of sternal deformity was significantly lower in experimental group than that in control group.Conclusions Lower sternal incision with beating heart can reduce surgical injury,simplify operative procedures and improve therapeutic efficacy.It is both safe and effective for CHD patients.