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目的 :介绍经右胸外侧小切口体外循环下小儿心脏直视手术的经验。 方法 :经右外侧第 4或第 3肋间入胸 ,体外循环下先天性心脏畸形矫治术 793例。修补房间隔缺损 180例 ,室间隔缺损 45 2例 ,室间隔缺损合并房间隔缺损 32例 ,法乐四联症 95例 ,部分心内膜垫缺损 17例 ,二尖瓣关闭不全 7例及其他畸形 10例 ;合并畸形包括 :动脉导管未闭 ,左上腔静脉 ,肺静脉畸形引流 ,右心室流出道狭窄 ,单冠状动脉畸形等。 结果 :本组患儿手术死亡 3例 (死亡率 0 .38% ) ,1例因术后低心输出量综合征 ,1例因严重肺部感染 ,1例因气管插管故障导致器官功能衰竭 ;其它患儿术后并发症少。 结论 :这种切口可安全有效地替代正中剖胸矫治某些小儿常见的心脏畸形 ,它具有损伤小 ,瘢痕隐蔽 ,不破坏胸廓完整性 ,防止术后鸡胸等优点 ,符合微创外科的原则。
OBJECTIVE: To introduce the experience of open heart surgery in pediatric patients undergoing extracorporeal small lateral incision under cardiopulmonary bypass. Methods: The right lateral fourth or third intercostal space chest, cardiopulmonary bypass cardiopulmonary bypass 793 cases. 180 cases of atrial septal defect repair, ventricular septal defect 452 cases, ventricular septal defect with atrial septal defect in 32 cases, tetralogy of Fallot 95 cases, partial endocardial cushion defect in 17 cases, mitral regurgitation in 7 cases and other Deformity in 10 cases; merger deformity, including: patent ductus arteriosus, left superior vena cava, pulmonary venous anomalies drainage, right ventricular outflow tract stricture, single coronary artery malformations. Results: There were 3 cases of death (0. 38%) in this group, 1 case of low cardiac output syndrome, 1 case of severe pulmonary infection and 1 case of organ failure due to endotracheal intubation ; Other children less postoperative complications. Conclusion: This incision can be a safe and effective alternative to the median thoracotomy correction of some common heart malformations in children. It has the advantages of small injury, hidden scars, does not destroy the integrity of the thorax, prevent postoperative chicken breast, in line with the principle of minimally invasive surgery.