右腋下直小切口在婴儿心脏直视手术中的应用

目的总结右腋下直小切口在婴儿常见先天性心脏病（先心病）心内直视手术中的应用经验。方法回顾性分析解放军第153中心医院2009年4月至2013年4月采用右腋下直小切口施行婴儿心脏直视手术369例患者的临床资料,其中男191例、女178例,年龄3～12（8.2±3.1）个月,体重4.5～11.2（7.8±4.5）kg。行室间隔缺损（VSD）修补术290例,房间隔缺损（ASD）修补术16例,VSD＋ASD修补术34例,VSD修补术＋二尖瓣成形术（MVP）4例,肺动脉瓣狭窄（PVS）交界切开术9例,ASD修补术＋PVS交界切开术6例,部分肺静脉异位引流（PAPVC）4例和部分房室管畸形（PECD）6例均行手术治疗。结果手术死亡6例（1.6%）。术后发生右肺不张3例,右侧气胸2例,肺部感染16例,切口液化12例,Ⅲ°房室传导阻滞1例,脑气栓1例,二次开胸止血3例。术后6个月至1年门诊随访295例,发现VSD残余漏4例,二尖瓣轻度关闭不全2例。结论在婴儿常见先心病直视手术中,采用右腋下直小切口可获得满意的临床效果,但需要严格把握手术适应证,熟练掌握手术要点。

Right Axillary Straight Mini-thoracotomy in Open Heart Surgery in Infants

Objective To summarize our experience of right axillary straight mini-thoracotomy for surgical treat- ment of common congenital heart diseases in infants. Methods We conducted a retrospective analysis of 369 infants undergoing open heart surgery through right axillary straight mini-thoracotomy in the 153th Central Hospital of People＇s Liberation Army from April 2009 to April 2013. There were 191 males and 178 females with their mean age of 8.2 ±3.1 months （range, 3-12 months） and body weight of 7.8±4.5 kg （rang, 4.5-11.2 kg）. Surgical procedures included ventricu- lar septal defect （VSD）repair in 290 patients, atrial septal defect （ASD）repair in 16 patients, VSD and ASD repair in 34 patients, VSD repair and mitral valvuloplasty in 4 patients, valvotomy for pulmonary valve stenosis （PVS）in 9 patients, ASD repair and valvotomy for PVS in 6 patients, correction of partial anomalous pulmonary venous connection in 4 pa- tients, and correction of partial atrioventricular canal defect in 6 patients. Results Six patients （1.6%） died postopera- tively. Postoperative complications included right atelectasis in 3 patients, right pneumothorax in 2 patients, pneumonia in 16 patients, incision fat liquefaction in 12 patients, third-degree atrioventricular block in 1 patient, cerebral air embolism in 1 patient, and reexploration for bleeding in 3 patients. A total of 295 patients were followed up for 6 to 12 months after discharge. Residual VSD shunt was found in 4 patients, and mild mitral regurgitation was found in 2 patients. Conclusion Clinical outcomes of right axillary straight mini-thoracotomy during open heart surgery are satisfactory for infants with common congenital heart diseases, but strict indications and skillful surgical techniques are needed.