摘要
目的对比研究在体外循环（CPB）下经右腋下小切口和胸骨正中切口矫治婴幼儿先天性心脏病的两种术式效果。方法取2005年9月至2014年9月我科婴幼儿先天性心脏病患者共126例，平均年龄（1．0±0．2）岁，平均体重（8．5±0．3）kg，均为简单型先天性心脏病，分成右腋下小切口组和胸骨正中切口组。比较两组患者的手术时间、CPB时间、术中阻断时间、术后呼吸机辅助时间、住院天数、术后引流量、术后并发症等指标。结果两组均取得满意临床效果。正中切口组无手术死亡，术后Ⅲ度房室传导阻滞2例2周内均恢复，肺不张1例，胸骨愈合不良1例。右腋下小切口组术后传导阻滞3例均恢复；死亡3例，2例为肺不张致肺部严重感染并全身败血症，1例心脏畸形合并动脉导管未闭（PDA），术中未能正确处理PDA，术后患者低心排而死亡。右腋下小切口组的术后胸液量为（50．64±10．81）ml，明显少于胸骨正中切口组的术后胸液量（86．11±11．25）ml，差异有统计学意义（P〈0．05）。手术时间、CPB时间、术中阻断时间、术后呼吸机辅助时间和住院天数两组之间未见统计学差异（P〉O．05）。结论经右腋下小切口矫治先天性心脏畸形安全、有效，能有效替代正中切口剖胸矫治简单的先天性心脏畸形。术前明确诊断为选择此种切口必要条件，但对非限制性室间隔缺损、合并动脉导管的复杂畸形选择此种切口要慎重。
Objective Comparing the results of cardiopulmonary bypass （CPB） operation between the fight axillary incision and the sternal incision in treatment of infants congenital heart disease. Methods A total of 126 cases of our cardiac surgery center from September 2005 to September 2014 in this study were divided into right subaxillary small incision group and sternum midline incision group, the average age of the group were （ 1.0± 0.2）years old, mean body weight of the group were （8.5±0.3）kg. 57 cases conginital heart dieases were repaired through a small incision under the right armpit the other 69 cases were repaired through a sternal incision. Two groups of patients were compared operative time, CPB time, blocking time intraoperative, postoperative ventilation time, length of stay, postoperative drainage, postoperative complications and other indicators. Results Both groups achieved satisfactory clinical results, the sternaltomy incision was no operative mortality, postoperative Ⅲ degree atrioventricular block in two cases, were recovered two weeks after, no operative mortality, 3 cases were Ⅲ degree atrioventricular block and recoveryed in right armpit group, three cases of death, two were atelectasis caused by lung atelectasis and systemic sepsis in patients with serious infections, one case of cardiac malformation combined patent ductus arteriosus（PDA）, PDA were failed to deal properly and the patiants were died of postoper- ative low cardiac output. Thoracic drainage of right axillary incision group （50.64±10.81）ml was significantly less than the amount of median sternotomv incision re＇nun（86.11±11.25 ）ml. there was a sianificant difference（P〈0.05） and the complication of right axillary incision group was significantly more than the amount of median sternotomy incision group. The operative time, CPB time, intraoperative blocking time, postoperative ventilation time and hos- pital stay of two groups was no significant difference （P〉O.05）. Conclusion The right axillary incision correction of congenital heart defects are safe, effective, and can effectively replace the median thoracotomy incision treat- ment of some common children atrial septal defect, ventricular septal defect, atrial septal defect combined ventric- ular septal defects and other congenital heart defects. Corect preoperative diagnosis are necessary and sufficient condit but for non-restrictive ventricular septal defect, complex malformation conbined PDA, selection of this inci- sion are prudently.
出处
《中国心血管病研究》
CAS
2015年第8期747-750,共4页
Chinese Journal of Cardiovascular Research
关键词
右腋下小切口
胸骨正中切口
心脏外科手术
Right axillary incision
Median sternotomy
Cardiac surgery operation
