右腋下直小切口在小儿心脏病手术中的应用

The results of right subaxillary miul-thoracotomy incision for the repair of congenital cardiac defects

目的总结右腋下微创直切口用于先天性心脏病矫治的经验。方法回顾性分析2010年3月至2013年6月间，采用右腋下微创直切口实施的先天性心脏病矫治121例，其中房间隔缺损（ASD）31例，室间隔缺损（VSD）82例（所有VSD均为膜部或膜周部），ASD合并VSD3例，部分型心内膜垫缺损（PECD）1例，ASD合并部分型肺静脉畸形引流（PAPvc）2例，ASD合并肺动脉瓣狭窄2例。结果全组手术顺利，无死亡，无严重并发症发生，无房室传导阻滞，无二次开胸止血术。体外循环时间（78＋18）rain，主动脉阻断时间（44．0±12．0）min，引流量（275±135）ml，术后呼吸机辅助呼吸3．0-9．5h，术后住院时间（6．8±1．4）d。出院时测量手术切口长4．3～6．5cm。结论右腋下微创直切口剖胸具有损伤小、恢复快、切口隐蔽美观、不破坏胸廓连续性等优点，值得临床推广。

Objective To summarize the experience of right subaxillary mini-thoracotomy in the treatment of congenital heart disease. Methods A total of 121 patients with congenital heart disease received right subaxillary mini-thoracotomy approach correction under cardiopulmonary bypass between July 2010 and June 2013. The cardiac defects includes 31 atrial septal defect （ASD）, 82 ventricular septal defect （VSD）, 3 combined ASD and VSD, 2 ASD combined with PAVC, 2 ASD combined with PS and 1 PECD. Results All the operations were successfully performed with good exposure. There were no operative death and complications. The cardiopulmonary bypass time was （ 78 ± 18 ） min, the cross - clamp time was （ 44.0 ±1 2.0 ） min, the drainage volume was （ 275 ±135 ） ml. The post operative average mechanical ventilation time was 3.0-9.5 hour. The average of the postoperative hospital stay was（6.8± 1.4）days. Conclusion Open heart surgery with the right subaxillary mini-thoracotomy is minimally invasive, safe and easily performed. Patients are satisfied with quick recovery and excellent cosmetic effect.