摘要
目的比较房间隔缺损修补术的经右胸前外侧小切口与胸部正中切口两种术式的效果。方法经右胸前外侧小切口心脏不停跳下修补房间隔缺损82例,其中合并中、重度肺动脉高压10例,部分型肺静脉畸形引流3例;经胸部正中切口心脏停跳下修补房间隔缺损67例,其中合并中、重度肺动脉高压11例,部分型肺静脉畸形引流5例。观察比较2组患者的体外循环(CPB)时间、重症监护(ICU)时间、术后呼吸机辅助时间、住院天数、术后引流量、切口长度等指标。结果2组均无手术死亡。右胸前外侧小切口手术方式的CPB时间(35.2±14.1) min、机械通气时间(6.5±2.5) h、术后住院时间(7.4±1.2) d和切口长度(6.5±0.9) cm均明显小于胸部正中切口手术方式的CPB时间(42.7±11.8) min、机械通气时间(7.9±3.8) h、住院时间(9.0±2.9) d 和切口长度(15.9±1.7) cm(P<0.01),前者术后引流量(237.6±172.5) ml小于后者术后引流量(304.3±192.4) ml(P<0.05)。ICU时间分别为(35.1±16.2) h和(32.3±24.1) h,无显著性差异(P>0.05)。结论右胸前外侧小切口心脏不停跳房间隔缺损修补术,畸形矫正效果满意,可靠安全,手术创伤小,术后住院时间短,操作简单,美容效果好,可取代常规胸部正中切口矫治房间隔缺损及其合并部分型肺静脉畸形引流。
Objective To compare the effect of right anterolateral minithoractomy and median sternotomy for atrial septal de-fect closure. Methods In this study, 82 patients, whose age ranged from 4 to 46 years with a mean of 15.7±8.6 years, under-went surgical repair of the atrial septal defects on the beating heart through right anterolateral minithoractomy. Ten of these cases were complicated by moderate to severe pulmonary hypertension, and 3 by partial anomalous pulmonary venous con-nection. Another 67 patients with an age range of 3 to 49 years (mean17.0±12.5 years) underwent surgical repair of the atrial septal defects through full-length median sternotomy with the heart beat arrested, and complication of moderate to severe pul-monary hypertension was identified in 11 cases and partial anomalous venous connection in 5. Comparisons were performed between the 2 groups in terms of the length of skin incision, cardiopulmonary bypass (CPB) time, postoperative mechanical ventilation time, intensive care unit stay, postoperative hospital stay, and the volume of postoperative drainage. Results There was no operative mortality in either of the 2 groups. In the former group, the CPB time (35.2±14.1 min), postoperative me-chanical ventilation time (6.5±2.5 h), postoperative drainage volume (237.6±172.5 ml), postoperative hospital stay (7.4±1.2 d) and skin incision length (6.5±0.9 cm) were all significantly less than those of the latter group of patients, whose CPB time was 42.7±11.8 min, postoperative mechanical ventilation time 7.9±3.8 h, postoperative drainage volume 304.3±192.4 ml, postop-erative hospital stay 9.0±2.9 d and skin incision length 15.9±1.7 cm (P<0.01). The intensive care unit stay did not differ signif-icantly between the 2 groups (35.1±16.2 h vs32.3±24.1 h, P>0.05). Conclusion A right anterolateral minithoracotomy for re-pairs of atrial septal defects is a safe, effective and simple technique to ensure minimal surgical invasion with shorter postoper-ative hospital stay. Minithoracotomy can
出处
《第一军医大学学报》
CAS
CSCD
北大核心
2003年第9期956-957,960,共3页
Journal of First Military Medical University
关键词
房间隔缺损
修补术
右胸前外侧小切口
胸部正中切口
手术方法
surgical procedures, minimally invasive
minithoracotomy
sternotomy
repair atrial septal defects