275例右胸小切口在心内直视手术中的应用

目的总结右胸小切口微创技术在先天性心脏病心内直视手术中应用的效果。方法 2000年1月～2011年12月,我科室应用右胸小切口完成各类先天性心脏病的心内直视手术共275例,其中175例在常规体外循环下完成,另外100例在浅低温心脏不停跳体外循环下完成。随机选择同期常规手术(胸正中切口+常规体外循环)患者80例作为对照。结果右胸小切口患者切口长度、手术时间及术后引流量都显著低于对照组;术后呼吸机辅助时间明显低于对照组;不停跳手术组CPB时间明显低于对照组和单纯右胸小切口组;术后监护时间各组间差异无统计学意义。结论右胸微创小切口是一种简洁、高效、经济的微创技术,可和不停跳技术联合应用达到双微创的手术效果。

Application of Limited Right Anterolateral Thoracotomy in 275 Cases of Open Heart Surgery for Congenital Heart Disease

Objective To explore the efficacy of limited right anterolateral thoracotomy in open heart surgery for congenital heart diseases.Methods From Jan.2000 to Dec 2011,275 patients underwent open heart surgery by limited right anterolateral thoracotomy in our department,175 cases were with routine cardiopulmonary bypass(CPB) and 100 with mild hypothermia CPB with beating heart.80 cases with the conventional operation(median sternotomy+CPB with arrested heart) were selected randomly as control.Results The duration of operation,length of incision,postoperative drainage volume and postoperative mechanical ventilation time in the patients undergoing limited right anterolateral thoracotomy were significantly lower than those of control group.The CPB time of "beating heart" group was significantly lower than that of control group and solely-right chest small incision group.There was no statistical difference in postoperative care time between all groups.Conclusion The minimally invasive right thoracotomy,as a simple,efficient,economic technique,especially combining with beating heart,has achieved double minimally invasive effect.