右腋下垂直切口在先天性心内畸形合并动脉导管未闭外科矫治中的应用

目的探讨通过右腋下垂直切口矫治合并动脉导管未闭(PDA)的先天性心内畸形的有效性和安全性。方法回顾性分析2014年8月至2019年8月通过右腋下垂直切口同时行先天性心脏病心内畸形矫治和PDA结扎术34例患者的临床资料,年龄0.5~6.1岁,男25例、女9例。结果手术切口长度3.0(3.0,3.5)cm,手术时间110.0(90.0,121.0)min,体外循环时间45.5(38.8,63.5)min,主动脉阻断时间22.5(14.8,34.8)min,出血量20.0(13.8,20.0)mL,住ICU时间17.0(5.5,22.3)h,术后机械通气时间为4.0(2.0,6.0)h,住院总费用为4.6(3.9,5.1)万元。围手术期和随访期间均无死亡和二次手术。中位随访时间636.0 d。随访期间有1例患者存在残余分流,未发现新发的脊柱侧弯、漏斗胸或鸡胸等胸廓发育异常。女性患者在随访期间无双侧乳腺发育不对称。所有患者的父母或监护人均对右腋下垂直美容切口满意。结论通过右腋下垂直切口同时进行先天性心内畸形矫治及PDA结扎术是一种安全有效的方法,具有良好的临床和美容学结果。

Right vertical infra-axillary thoracotomy in surgical repair for intra-cardiac congenital heart defects combined with patent ductus arteriosus

Objective To investigate effectiveness and safety of right vertical infra-axillary thoracotomy(RVIAT)in surgical repair for intra-cardiac anomalies combined with patent ductus arteriosus(PDA).Methods We retrospectively analyzed the clinical data of 34 patients who underwent intra-cardiac correction of congenital heart defects and PDA ligation simultaneously via RVIAT in our hospital from August 2014 to August 2019.There were 25 males and 9 females with an age range of 0.5-6.1 years.Results The length of incision was 3.0(3.0,3.5)cm.The operation time lasted 110.0(90.0,121.0)min.The cardiopulmonary bypass time was 45.5(38.8,63.5)min and the aortic cross-clamp time was 22.5(14.8,34.8)min.The bleeding volume was 20.0(13.8,20.0)mL.ICU stay time was 17.0(5.5,22.3)h,post-operative mechanical ventilation time was 4.0(2.0,6.0)h,total in-hospital cost was 46(39,51)thousand yuan.There was no mortality or reoperation during perioperative and follow-up period.Within the median follow-up of 636.0 days,1 patient had minimal residual ventricular septal defect shunt while no new-onset scoliosis,funnel chest or pectus carinatum was detected.No bilateral mammary developmental asymmetry was observed in the female patients during the follow-up period.All the patients’parents or guardians were satisfied with the right vertical infra-axillary aesthetic skin incision.Conclusion The minimally invasive repair for intra-cardiac heart defects combined with PDA via RVIAT is a safe and effective method with minimal invasiveness and excellent cosmesis.