摘要
目的 总结经右外侧小切口剖胸在先天性心脏病手术中应用的体会。 方法 1994年 10月～ 2 0 0 3年 3月 ,共完成经右外侧体外循环下先天性心脏畸形矫治术 12 5 8例。心内畸形包括房间隔缺损 2 93例、室间隔缺损 6 0 4例、室间隔缺损合并房间隔缺损 98例、法乐氏四联症 177例、部分心内膜垫缺损 2 9例及其它畸形 5 7例。合并畸形包括 :动脉导管未闭 ,永存左上腔静脉 ,二尖瓣关闭不全 ,肺静脉畸形引流 ,右室流出道狭窄等。 结果 本组手术死亡 9例 (0 7% ) ,其中 5例因术后低心输出量综合征 ,2例因严重肺感染 ,1例因灌注肺 ,1例因肺高压危象。术后并发症 36例 (2 9% )。体外循环时间 (6 0 3±32 1)分 (15分～ 35 9分 ) ,心肌阻断时间 (37 7± 2 4 6 )分 (3分～ 2 0 5分 )。术后机械通气 (19 7± 34 4 )小时 (1 5小时～ 4 0 1小时 ) ,住院时间 (8 0± 12 1)天 (5天～ 30 0天 )。 结论 右外侧小切口具有损伤小、瘢痕隐蔽、不破坏胸廓连续性、防止术后鸡胸等优点 。
ObjectiveTo summarize the experience of right mini-thoracotomy in the treatment of congenital cardiac defects.MethodsA total o f 1258 patients with congenital cardiac defects received right thoracotomy approach correction u nder cardiopulmonary bypass between October 1994 and March 2003. The cardiac def ects included 293 cases of atrial septal defect, 604 cases of ventricular septal defect, 98 cases of atrial septal defects associated with ventricular septal de fects, 177 cases of Fallot's Tetralogy, 29 cases of partial endocardial cushion defects, and 57 cases of other defects. Complicating anomalies were as follows: patent ductus arteriosus, left superior vena cava, mitral insufficiency, anomalo us pulmonary venous connection, right ventricular outflow tract obstruction, etc .ResultsAmong the 9 fatal cases (0.7%) in the study, 5 succu mbed to low card iac output, 2 to severe pulmonary infection, 1 to perfusive lung injury, and 1 t o pulmonary hypertension crisis. Postoperative complications occurred in 36 case s (2 9%). The cardiopulmonary bypass time was (60 3±32 1) min (range, 15 min ～359 min), the aortic crossclamping time was (37 7±24 6) min (range, 3 min～ 205 min ), the duration of postoperative mechanical ventilation was (19 7±34 4) hours ( range, 1 5 hours～401 hours), and the postoperative hospital stay was (8 0±12 1) days (range, 5 days～300 days).ConclusionsRight mini-thorac otomy is minimall y invasive, without impairing the integrity of the bony thorax. It gives excelle nt cosmetic results and prevents patients from postoperative pigeon chest.
出处
《中国微创外科杂志》
CSCD
2003年第5期382-383,405,共3页
Chinese Journal of Minimally Invasive Surgery
关键词
心脏直视手术
右侧剖胸
Open heart surgery
Right thoracotomy
