[1]刘迎龙　 闫军　 李守军　 于存涛　 张宏家①　 魏波.右外侧小切口剖胸在先天性心脏病手术中的应用[J].中国微创外科杂志,2003,03(5):382-405.
　Liu Yinglong,Yan Jun,Li Shoujun,et al.Application of right mini-thoracotomy in the treatment of congenital cardiac defects[J].Chinese Journal of Minimally Invasive Surgery,2003,03(5):382-405.
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右外侧小切口剖胸在先天性心脏病手术中的应用()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
03
期数:
2003年5期
页码:
382-405
栏目:
出版日期:
2003-05-31

文章信息/Info

Title:
Application of right mini-thoracotomy in the treatment of congenital cardiac defects
作者:
刘迎龙　 闫军　 李守军　 于存涛　 张宏家①　 魏波　
中国医学科学院中国协和医科大学阜外心血管病医院小儿先天性心脏病中心,北京,100037
Author(s):
Liu Yinglong; Yan Jun; Li Shoujun; et al.
CongenitalHeart Disease Center,FuwaiHospital,Beijing100037,China
关键词:
心脏直视手术; 右侧剖胸
Keywords:
Open heart surgery; 　Right thoracotomy
分类号:
R654.2
文献标志码:
A
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～2003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1258例.心内畸形包括房间隔缺损293例、室间隔缺损604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29例及其它畸形57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(60.3±32.1)分(15分～359分),心肌阻断时间(37.7±24.6)分(3分～205分).术后机械通气(19.7±34.4)小时(1.5小时～401小时),住院时间(8.0±12.1)天(5天～300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,符合微创外科的原则.
Abstract:
Objective　To summarize the experience of right mini-thoracotomy in the treatment of congenital cardiac defects.　 Methods　Atotal of 1258 patientswith congenital cardiac defects received rightthoracotomy approach correction under cardiopulmonary bypass between October 1994 and March 2003. The cardiac defects included 293 cases of atrial septal defect, 604 cases of ventricular septal defect, 98 cases of atrial septal defects associatedwith ventricular septal defects, 177 cases of Fallot’sTetralogy, 29 cases of partial endocardial cush- ion defects, and 57 cases of other defects. Complicating anomalieswere as follows: patent ductus arteriosus, left superior vena cava, mitral in- sufficiency, anomalous pulmonary venous connection, right ventricular outflowtract obstruction, etc.　Results　Among the 9 fatal cases (0. 7%) in the study, 5 succumbed to low cardiac output, 2 to severe pulmonary infection, 1 to perfusive lung injury, and 1 to pulmonary hyper- tension crisis. Postoperative complications occurred in 36 cases (2·9%). The cardiopulmonary bypass time was (60·3±32·1) min (range, 15 min~359 min), the aortic crossclampingtimewas (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).　Conclusions　Right mini-thoracotomy is minimally invasive, without impairing the integrity of the bony thorax. It gives excellent cosmetic results and prevents patients from postoperative pigeon chest.

参考文献/References:

［1］Rosengart TK, Stark JF. Repair of atrial septal defect through a right thoracotomy. Ann Thorac Surg, 1993, 55:1138- 1140.
［2］Bedard P, Keon WJ, Brais MP, et al. Submammary skin incision as a cosmetic approach to median sternotomy. Ann Thorac Surg, 1986,41:339-341.
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［7］刘迎龙, 张宏家, 孙寒松,等. 右外侧小切口剖胸小儿先天性心脏畸形矫治术793例体会. 中国循环杂志, 2000,15:202-204.
［8］Liu YL, Wang Q, Zhu XD, et al. Pulmonary artery perfusion with protective solution reduces lung injury after cardiopulmonary bypass. Ann Thorac Surg, 2000, 69: 1402-1407.

备注/Memo

备注/Memo:
①（北京安贞医院心血管外科,北京,100029）　
更新日期/Last Update: 2014-07-02