倒"J"形胸骨下段小切口在小儿心内直视手术中的应用

目的探讨应用倒"J"形胸骨下段小切口行小儿心内直视手术的安全性和手术创伤情况.方法应用倒"J"形胸骨下段小切口,对小儿先天性心脏畸型患者行心内直视手术矫治.全组50例,年龄8个月至14岁.手术主要病种:ASD、VSD、VSD PDA、ASD PS、PS.与近年相同年龄组标准胸骨正中切口比较.结果①切口长度明显缩小.②小切口的上端未超过胸骨角,在某种程度上满足了患者的美容需求.③术后胸廓的稳定性较好,术后胸廓畸形的发生率和程度明显减轻.④应用小切口能较好完成房间隔缺损,膜部及干下型室间隔缺损,肺动脉瓣狭窄等手术;但部分心内手术结构的显露受到一定影响.结论只要手术适应证选择合适,应用倒"J"形胸骨下段小切口,并不影响手术安全性;可取得创伤小、术后胸廓畸形轻和较好的美容效果.

Lower invert "J" mini-sternotomy approach for open heart surgery in children

Objective To investigate the feasibility of lower invert "J" mini-sternotomy approach for open heart surgery in children. Methods Fifty children with congenital heart disease,aged eight months to fourteen years old, were operated with lower invert "J" mini-sternotomy approach for correction of ASD,VSD,VSD+PDA,ASD+PS and PS.Patients operated with standard median sternotomyserved as control. Results (1)The length of mini-sternotomy approach was shorter than that of standard median sternotomy. (2)The superior margin of modified lower mini-sternotomy approach was lower than angle of sternum and have better cosmetic effect.(3)The stability of thoracic cage have been better improved after operations. (4) Most surgical technique for ASD, VSD, PS could be finished with this mini-sternotomy approach, although exposure of the intracardiac structure in some operation is limited. Conclusion The lower mini-sternotomy approach is safe and less invasive in open heart surgery for some congenital heart disease and has better cosmetic effect.