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目的总结经右侧腋下直切口修补小儿干下型室间隔缺损的临床结果及手术经验,探讨此技术的可行性。方法回顾性分析2009年3月至2013年1月郑州大学第一附属医院27例干下型室间隔缺损经右侧腋下直切口行手术治疗的临床资料,其中男20例、女7例,年龄1.1~11.0(4.4±2.8)岁,体重7.6~28.0(14.6±5.3)kg。全身麻醉成功后,患者取左侧90°卧位,沿腋中线在第3肋骨上缘和第5肋骨下缘之间做垂直切口,经第4肋间进胸,沿膈神经前2 cm纵向切开心包并悬吊,升主动脉及上、下腔静脉分别插管建立体外循环。经肺动脉纵切口补片修补缺损。体外循环结束后,拔除主动脉插管,间断缝合心包,经第6肋间置胸腔引流管。于术后3个月、6个月和/或12个月随访,了解患者家属满意度,复查胸部X线片、心电图和超声心动图等。结果经右侧腋下直切口顺利完成手术,无操作困难,无需延长手术切口或改变手术切口类型。无围手术期死亡,无二次开胸止血、术后肺不张、肺部感染、胸腔积液、中枢神经系统损害、膈神经损伤、切口愈合不良或切口感染和心包积液等并发症发生。胸部切口长度4.4~7.0(5.07±0.66)cm。出院前复查超声心动图提示无残余分流。所有患儿均得到随访,分别于术后3个月、6个月和/或12个月经门诊或电话随访。随访期间无死亡患儿,未见室间隔缺损残余分流,未见胸廓不对称。随访时见胸部切口长度短,位于腋窝下,隐蔽美观,所有患儿家属对此切口满意。结论经右侧腋下直切口修补小儿干下型室间隔缺损具有可行性和安全性,且其诸多优点能使干下型室间隔缺损患儿受益。
Objective To summarize the clinical results and surgical experience of repairing pedicled inferior ventricular septal defect through the right axillary straight incision to explore the feasibility of this technique. Methods From March 2009 to January 2013, the clinical data of 27 cases of dry type ventricular septal defect treated by right axillary straight incision were retrospectively analyzed. Among them, 20 were males and 7 were females, Their ages ranged from 1.1 to 11.0 (4.4 ± 2.8) years and ranged from 7.6 to 28.0 (14.6 ± 5.3) kg. After the success of general anesthesia, the patient was taken to the left 90 ° supine position, along the midaxillary line in the third rib between the upper edge and the fifth rib between the vertical cut, the fourth intercostal space into the chest, along the longitudinal direction of the phrenic nerve 2 cm Open the pericardium and suspension, ascending aorta and inferior vena cava were intubated to establish cardiopulmonary bypass. Pulmonary artery longitudinal incision patch repair defect. After cardiopulmonary bypass, the aortic cannula was removed and the pericardium was interrupted. The sixth intercostal space was placed in the chest drainage tube. Patients were followed up for 3 months, 6 months and / or 12 months to find out the satisfaction of their family members, review of chest X-ray, electrocardiogram and echocardiography. Results The right axillary straight incision successfully completed the operation, no operational difficulties, no need to extend the surgical incision or change the type of surgical incision. No perioperative death, no secondary thoracotomy, postoperative atelectasis, pulmonary infection, pleural effusion, central nervous system damage, phrenic nerve injury, incisional wound healing or incision infection and pericardial effusion and other complications . Chest incision length 4.4 ~ 7.0 (5.07 ± 0.66) cm. Pre-discharge echocardiography review suggested no residual shunt. All children were followed up for outpatient visits or phone calls at 3 months, 6 months and / or 12 months after surgery. No children died during follow-up, no residual shunt ventricular septal defect, no chest asymmetry. See the length of chest incision short, located under the armpits, concealed beautiful, all children with this family members satisfied with the incision. Conclusions It is feasible and safe to repair the inferior ventricular septal defect through the right axillary incision, and its advantages can benefit the children with.