微创右腋下直切口与常规胸骨正中切口手术治疗室间隔缺损的效果

目的比较微创右腋下直切口与常规胸骨正中切口手术治疗室间隔缺损的效果。方法将实施室间隔缺损修补术的80例室间隔缺损患儿随机分为2组,各40例。对照组经常规胸骨正中切口手术,观察组实施微创右腋下直切口手术。比较2组的临床效果。结果 2组患者均顺利完成手术,无手术死亡病例。2组术后体外循环时间、呼吸机辅助时间差异无统计学意义(P0.05)。观察组手术时间,术后引流量、住院时间及术后并发症发生率均优于对照组,差异有统计学意义(P0.05)。结论与常规胸骨正中切口比较,应用微创右腋下直切口行室间隔缺损修补手术治疗室间隔缺损,创伤小、术后恢复时间快、并发症少、安全性高。     

胸部不同切口治疗小儿常见先天性心脏病的比较

目的 比较胸部不同切口治疗小儿常见先天性心脏病的临床结果.方法 回顾分析1999年1月至2001年12月采用胸部不同切口治疗小儿常见先天性心脏病1 669例,并根据胸部不同切口分成正中胸骨切口组(Med组),胸骨下段小切口组(Pt组)和胸部右侧切口组(Rat组),其中行房间隔缺损(ASD)修补术245例, 室间隔缺损(VSD)修补术1 005例,法洛四联症(TOF)根治术419例.结果 ASD修补术中,Rat组肺部并发症的发生率高于Med组和Pt组(P<0.05);VSD修补术中,Rat组术前肺动脉高压的比率低于 Med 组和Pt组(P<0.05),而术后肺部并发症的发生率则高于Med组和Pt组(P<0.05);TOF根治术中,Med组术前血红蛋白浓度、动脉血氧饱和度分别高于及低于Rat组和Pt组(P<0.05),术中跨肺动脉瓣环补片比率却高于Rat组和Pt组(P<0.05).结论 手术切口的选择应当保证心内畸形的矫正,最大限度地减少手术并发症,保证患者的安全.     

中国人移植的乳内动脉平均流量测定及影响因素

目的 比较胸部不同切口治疗小儿常见先天性心脏病的临床结果.方法 回顾分析1999年1月至2001年12月采用胸部不同切口治疗小儿常见先天性心脏病1 669例,并根据胸部不同切口分成正中胸骨切口组(Med组),胸骨下段小切口组(Pt组)和胸部右侧切口组(Rat组),其中行房间隔缺损(ASD)修补术245例,室间隔缺损(VSD)修补术1 005例,法洛四联症(TOF)根治术419例.结果 ASD修补术中,Rat组肺部并发症的发生率高于Med组和Pt组(P<0.05);VSD修补术中,Rat组术前肺动脉高压的比率低于 Med 组和Pt组(P<0.05),而术后肺部并发症的发生率则高于Med组和Pt组(P<0.05);TOF根治术中,Med组术前血红蛋白浓度、动脉血氧饱和度分别高于及低于Rat组和Pt组(P<0.05),术中跨肺动脉瓣环补片比率却高于Rat组和Pt组(P<0.05).结论 手术切口的选择应当保证心内畸形的矫正,最大限度地减少手术并发症,保证患者的安全.     

留置皮下或关节腔内引流在人工膝关节置换术中的比较研究

目的 比较留置皮下或关节腔内引流在人工膝关节置换术中对疗效的影响。方法 将2013年5月至2015年5月于我院行单侧全膝关节置换术的96例患者随机分为皮下组和关节腔组各48例,皮下组在缝合深筋膜后留置皮下引流管进行引流,而关节腔组缝合深筋膜前将引流管留置于关节腔内进行引流。对比两组患者术后失血情况(引流量、血红蛋白和红细胞压积下降程度、隐性失血量)、切口相关并发症以及术后不同时间点的关节功能评分。结果 皮下组患者的术后引流量、血红蛋白和红细胞压积下降程度分别为(163.45±83.53)ml、(26.34±8.26)g/L、(17.46±5.26)%,均显著低于关节腔组[(426.53±112.3)ml、(35.26±9.26)g/L、(23.26±6.34)%],差异有统计学意义(P<0.05)。两组患者在异体输血率、隐性失血量、切口相关并发症、术后膝关节功能等方面差异无统计学意义(P>0.05)。结论 在人工膝关节置换手术中,缝合深筋膜后留置皮下引流的方式相较于常规关节腔内引流,可以显著减少术后引流量、术后血红蛋白和红细胞压积下降程度,而且在隐性失血量、并发症发生率以及膝关节功能恢复方面并无明显差异。     

不同手术入路全髋关节置换术临床疗效分析

目的探讨微创前外侧入路与传统后外侧入路行全髋关节置换术临床疗效。方法回顾性分析本院2012年2月至2013年12月期间96例获得1年以上随访的全髋关节置换临床资料,其中采用微创前外侧入路48例(观察组),传统后外侧入路48例(对照组),通过比较两组手术时间、切口长度、术中失血量、住院时间、术后并发症及术后髋关节Harris功能评分等,对两种手术入路进行疗效评价。结果观察组术中失血量、切口长度及住院时间与对照组相比明显减小(P<0.05),但手术时间与对照组相比较长(P<0.05);观察组术后3月、6月及1年髋关节Harris功能评分较对照组明显升高(P<0.05);且观察组术后并发症发病率明显低于对照组(P<0.05)。结论微创前外侧入路全髋关节置换术能够有效减少创伤、术中出血量及缩短住院时间,减少术后并发症,提高髋关节功能,值得临床推广。     

胸部小切口微创手术治疗先天性心脏病的早期结果

目的 总结右或左前外胸部小切口治疗先天性心脏病的早期结果.方法 2010年4月到2012年12月,63例先天性心脏病患者采用右或左前外胸部小切口的方法完成手术,其中男22例,女41例;年龄30.6岁.手术包括房间隔缺损修补术38例,室间隔缺损修补术19例,部分心内膜垫缺损矫治术3例,肺静脉异位引流矫治术1例,Ebstein畸形矫治术1例,主动脉窦瘤破裂修补术1例.结果 手术切口长度2.5～7.0 cm,平均(4.76±0.95) cm.全组无中转大切口开胸手术,无手术死亡.体外循环36～209 min,平均(76.38 ±29.97) min;主动脉阻断0～ 138 min,平均(33.49±31.50) min.气管插管2～37 h,平均(10.53±6.13)h;监护室停留4～42 h,平均(14.93±7.65)h;术后住院2～ 14天,平均(5.42±1.98)天.9例输血,54例未输血.随访1 ～32个月,平均(13.75 ±8.91)个月,超声心动图提示所有患者无残余漏,一般情况佳.结论 胸部小切口微创治疗先天性心脏病安全、可行.     

选择性脾动脉栓塞与脾修补术治疗外伤性脾破裂的比较

目的比较选择性脾动脉栓塞术与脾修补术的临床应用。方法回顾性分析1992-2004年我院进行的16例选择性脾动脉栓塞和23例脾修补术。结果2组病人均无死亡病例。选择性脾动脉栓塞组2例有术后并发症,脾修补术组10例有术后并发症(P<0.05)。选择性脾动脉栓塞组病人无输血,脾修补术组16例输血,平均输血(682.6±377.3)ml(P<0.05)。选择性脾动脉栓塞组平均住院日(7.3±1.1)d,脾修术组平均住院日(10.4±4.4)d(P<0.05)。选择性脾动脉栓塞组平均手术时间(1.9±0.6)h,脾修补术组平均手术时间(3.0±0.6)h(P<0.05)。结论选择性脾动脉栓塞与脾修补术的治疗效果相同。选择性脾动脉栓塞比脾修补术输血少,术后并发症少,住院时间短,手术时间短。     

右胸前外侧小切口心内直视术102例

目的　总结选择性应用右胸前外侧小切口在体外循环 (CPB)下行心内直视手术的临床经验。　方法　对10 2例先天性心脏病及风湿性二尖瓣病变患者均采用右胸前外侧小切口进行心内直视手术。　结果　全组无手术死亡 ,术后 6例发生少量胸腔积液 ,出院时自然吸收 ,无其它并发症发生。术后胸腔引流量 4 0～ 32 0 ml,平均 14 0 .0±2 1.5 ml,较同期同类手术患者胸腔引流量少。　结论　右胸前外侧小切口行心内直视手术是一种安全可靠的微创手术 ,易掌握 ,但不适用于复杂的心内直视手术。     

右胸前外侧小切口房间隔缺损修复术

右胸前外侧小切口房间隔缺损修复术周凯＊张仁福朱洪玉赁常文张南滨汪曾炜房间隔缺损（ＡＳＤ）是常见先天性心脏畸形，经胸部正中切口修复创伤大，且术后切口疤痕增生明显。自１９９３年１２月～１９９６年１０月我们对６１例女性患者采取经右胸前外侧小切口行ＡＳＤ修复...     

微创心脏不停跳下房间隔缺损修补术（附46例报告）

目的报告经右侧腋下小切口，在心脏不停跳下修补房间隔缺损的手术方法及结果。方法1997年1月至2000年3月，为46例房间隔缺损经右侧腋下小切口，在心脏不停跳下完成了缺损修补术，其中1例功能性单心房，2例部分型肺静脉(右侧)畸形引流，3例中度肺动脉高压。结果平均切口长度(7.2±1.1)cm。平均体外循环时间(30.3±7.8)分钟。术后所有患者无房水平分流及手术相关并发症，37例随访3月～2.4(1.3±0.6)年。所有患者心功能良好，无并发症。结论右侧腋下小切口心脏不停跳下房间隔缺损修补术，是一种安全、可靠、美观、微创的手术方法。     

Partial median sternotomy as a minimal access for the closure of subarterial ventricular septal defect

Background: Minimally invasive techniques in congenital heart surgery have evolved steadily over the past few years, but documentation in the literature is rare. The majority of reported techniques involve thoracoscopic approach and partial sternotomy. We have employed a lower partial sternotomy as a minimal-access procedure for the closure of subarterial ventricular septal defect, for situation where this approach would be unsuitable for adequate exposure of the pulmonary artery. The purpose of this study is to demonstrate the feasibility and safety of this technique and report its superior cosmetic result. Subjects and Methods: Beginning in 1997, we began approaching the closure of subarterial ventricular septal defect through a lower sternal split incision using a 6 to 10 cm skin opening, associated with a reversed L incision at the left second intercostal space. A total of consecutive 12 patients (6 male and 6 female) have been operated on using this approach. The patients ranged in age from 6 to 21 years (mean, 12.8 ± 5.0 years). The straight cannula with stylet was used for aortic cannulation. Results: There was no mortality or morbidity, except for late pericardial effusion in 4 cases. The durations of cardiopulmonary bypass and aortic cross-clamping ranged from 94 to 206 (mean, 131 ±33) minutes and from 40 to 122 (mean, 70 ± 26) minutes, respectively. Ten of 12 patients were extubated in the operating room, and no patient required blood transfusion. The postoperative hospital stay ranged from 8 to 21 (mean, 13.4 ± 4.2) days. No patient developed deterioration of aortic regurgitation or residual ventricular septal defect. Conclusions: Our experience demonstrates that the lower partial sternotomy for the closure of subarterial ventricular septal defect is technically feasible and can be used with excellent cosmetic results and safety. Although experience is limited and follow-up is relatively short, this less invasive surgical technique may become a beneficial option for the management of subarterial ventricular septal defect.     

Partial median sternotomy as a minimal access for the closure of subarterial ventricular septal defect. Feasibility of transpulmonary approach.

BACKGROUND: Minimally invasive techniques in congenital heart surgery have evolved steadily over the past few years, but documentation in the literature is rare. The majority of reported techniques involve thoracoscopic approach and partial sternotomy. We have employed a lower partial sternotomy as a minimal-access procedure for the closure of subarterial ventricular septal defect, for situation where this approach would be unsuitable for adequate exposure of the pulmonary artery. The purpose of this study is to demonstrate the feasibility and safety of this technique and report its superior cosmetic result. SUBJECTS AND METHODS: Beginning in 1997, we began approaching the closure of subarterial ventricular septal defect through a lower sternal split incision using a 6 to 10 cm skin opening, associated with a reversed L incision at the left second intercostal space. A total of consecutive 12 patients (6 male and 6 female) have been operated on using this approach. The patients ranged in age from 6 to 21 years (mean, 12.8 +/- 5.0 years). The straight cannula with stylet was used for aortic cannulation. RESULTS: There was no mortality or morbidity, except for late pericardial effusion in 4 cases. The durations of cardiopulmonary bypass and aortic cross-clamping ranged from 94 to 206 (mean, 131 +/- 33) minutes and from 40 to 122 (mean, 70 +/- 26) minutes, respectively. Ten of 12 patients were extubated in the operating room, and no patient required blood transfusion. The postoperative hospital stay ranged from 8 to 21 (mean, 13.4 +/- 4.2) days. No patient developed deterioration of aortic regurgitation or residual ventricular septal defect. CONCLUSIONS: Our experience demonstrates that the lower partial sternotomy for the closure of subarterial ventricular septal defect is technically feasible and can be used with excellent cosmetic results and safety. Although experience is limited and follow-up is relatively short, this less invasive surgical technique may become a beneficial option for the management of subarterial ventricular septal defect.     

Full sternotomy with minimal skin incision for congenital heart surgery

PURPOSE: The purpose of this paper is to analyze the feasibility of the full sternotomy with minimal skin incision and its related complications and risks. METHODS: A total of 405 patients with simple congenital heart disease underwent open heart surgery exclusively under full sternotomy with minimal skin incision. We reviewed the available medical records of the patients retrospectively. Bypass time, aorta cross clamp time, and period of hospital stay were compared with the control group (223 patients with standard long skin incision). RESULTS: Full sternotomy with minimal skin incision provided adequate surgical views and successful repair was done in all patients. There was no mortality. One patient had chylopericardium after the operation and another patient had a postoperative bleeding at the sternum. Minimal skin incision took the similar aorta cross-clamp time and total cardiopulmonary bypass time compared with full skin incision in atrial septal defect patients. Among the ventricular septal defect patients, minimal skin incision took a little longer aorta cross-clamp time (10%), but similar total cardiopulmonary bypass time compared with full skin incision. CONCLUSION: Minimal skin incision with full sternotomy provides improved cosmetic results. There was no increased mortality and morbidity using minimal access. It can be applied to more complex congenital heart disease contrast to other minimal invasive techniques for atrial septal defect.     

微创直视手术在成人先天性心脏病中的应用（附52例分析）

目的 初步评价微创直视心脏手术治疗成人先天性心脏病的安全性和有效性.方法 2010年4月～ 2012年12月,单组共完成微创直视先天性心脏病手术52例.建立闭式体外循环,做右胸前外侧切口3 ～～5 cm,经肋间入胸腔,剪开心包,进入心腔完成畸形矫治.实施手术包括房间隔缺损（ASD）修补术29例,室间隔缺损（VSD）修补术15例,部分型心内膜垫缺损（PECD）矫治术2例,Ebstein畸形矫治术2例,二次二尖瓣置换术（redo-MVR）1例,主动脉窦瘤修补1例,主动脉窦瘤修补联合主动脉瓣置换术（AVR）1例,二尖瓣成形术（MVP）1例.同期手术包括三尖瓣成形术（TVP）5例,射频消融术2例,肺动脉瓣狭窄（PS）球囊扩张术1例,MVR术1例.结果 手术均在闭式体外循环下完成,无转为传统胸正中切口开胸手术.手术时间（3.7±0.8）h.体外循环时间36 ～209 min,（76.9±31.3）min.心脏不停跳下完成手术25例;心脏停跳下完成手术27例,主动脉阻断时间13 ～ 138 min,（57.6±18.2）min,术后自动复跳23例.气管插管时间3～30 h,（10.9±4.0） h;ICU时间9～41 h,（16.7±4.4）h;术后住院时间3～14d,（5.4±4.1）d;切口长度3～5 cm,（4.5±0.6）cm;术后第1天引流量（349.5±294.2）ml;34例（65.4％）未输血.无围术期及出院后死亡,无二次开胸探查止血和切口感染.出院时心功能Ⅰ级45例,Ⅱ级6例,Ⅲ级1例.25例随访时间1 ～ 24月,（7.0±4.5）月,无明显并发症发生,心功能均为Ⅰ级.结论 微创直视手术在成人先心病应用的近期手术效果良好,适用范围相对广泛,具有创伤小、切口美观、无胸骨感染并发症等特点.     

Minimally invasive cardiac surgery--the efficacy of right parasterna approach

The recent concepts of minimally invasive surgery have affected even cardiovascular surgery. Especially, the desire to lessen incisional pain and hospital stay has made minimally invasive cardiac surgery (MICS) desirable. However, its efficacy is still controversial. To investigate this goal, we assessed the efficacy of avoidance of median sternotomy through right parasternal approach in view of the postoperative bleeding, % transfusion, postoperative intubation period, degree of incisional pain and serum level of cytokines. Patients with mitral valve disease or atrial septal defects were divided into the MICS (M) group and the control (C) group. In the M group, operations were performed through right parasternal incision under cardiopulmonary bypass (CPB) instituted by placing a venous cannula directly into superior vena cava and arterial and the other venous cannulae into femoral artery and vein. On the other hand, in the C group, operations were performed through median sternotomy under conventional CPB. There were no significant differences in CPB and AXC time between two groups. The M group showed significantly lower value in the postoperative bleeding volume, % transfusion, postoperative intubation time. Patients in the M group showed higher satisfaction of small incision as compared with those in the C group. Serum level of IL-8 after CPB was significantly lower in the M group than in the C group. These results suggested that MICS for mitral disease or ASD appears to be less invasive when median sternotomy is avoided. This suggest that MICS is a promising and contributed approach for open heart surgery to improve the QOL of the patients.     

Transxiphoid approach for intracardiac repair using video-assisted cardioscopy

Video-assisted cardioscopy (VAC) is a novel tool for providing clear visualization of small intracardiac structures and achieving complete repair in minimally invasive surgery. Between July 1999 and July 2000, 12 patients with atrial septal defect and ventricular septal defect underwent surgical repair using a combined procedure with the transxiphoid approach and VAC in our institution. The mean skin incision was 5.4 cm, and the postoperative courses of all the patients were uneventful without any complications. The mean hospital stay was 8.3 days and 1 patient (8.3%) needed blood products. Our experience showed the technical feasibility and acceptable surgical results of transxiphoid approach using a VAC.     

Minimally invasive mitral valve surgery: mini-sternotomy with extended transseptal approach.

A partial upper sternotomy and an extended transseptal incision provide excellent exposure for mitral valve surgery. From March 1997 to December 1998, 462 patients had mitral valve surgeries using this minimally invasive approach. Eighty-seven percent had mitral valve repair, and 13% had mitral valve replacement. Thirteen patients (3%) required conversion to full sternotomy, and all other patients had the procedure completed using the initial approach. Forty-eight percent of patients were extubated within 6 hours of surgery, and 47% of patients spent less than 24 hours in the intensive care unit (ICU). Mean hospital length of stay was 7.2 +/- 5.4 days. Eighty-six percent of patients received no blood products. There was 1 hospital death (0.2%). Morbidity included reexploration for bleeding (4%), respiratory insufficiency (1%), stroke (1%), myocardial infarction (0.2%), and wound infection (0.2%). We conclude that virtually all mitral valve procedures, including complicated repairs, can be accomplished via partial upper sternotomy with an extended transseptal incision. This approach provides excellent exposure of the mitral valve and results in a low rate of wound complications, low transfusion requirements, and excellent cosmesis.     

Pericardial drainage prior to operation contributes to surgical repair of traumatic cardiac injury

We report on two cases of successful surgical repair of cardiac injury: one involving a left ventricular stab injury and the other a blunt rupture of the right atrium. Each patient underwent emergency surgical repair, the former via left anterolateral thoracotomy and the latter via median sternotomy, following pericardial drainage tube insertion from the subxiphoid area. The operative approach was chosen according to the color of drained blood, i.e., arterial bleeding indicated left anterolateral thoracotomy, while venous bleeding indicated median sternotomy. We conclude that pericardial drainage via the subxiphoid approach prior to induction of anesthesia is an easy and useful technique to perform, not only to release cardiac tamponade but to determine the operative approach in patients suffering from cardiac tamponade following cardiac injury.     

Pericardial drainage prior to operation contributes to surgical repair of traumatic cardiac injury.

We report on two cases of successful surgical repair of cardiac injury: one involving a left ventricular stab injury and the other a blunt rupture of the right atrium. Each patient underwent emergency surgical repair, the former via left anterolateral thoracotomy and the latter via median sternotomy, following pericardial drainage tube insertion from the subxiphoid area. The operative approach was chosen according to the color of drained blood, i.e., arterial bleeding indicated left anterolateral thoracotomy, while venous bleeding indicated median sternotomy. We conclude that pericardial drainage via the subxiphoid approach prior to induction of anesthesia is an easy and useful technique to perform, not only to release cardiac tamponade but to determine the operative approach in patients suffering from cardiac tamponade following cardiac injury.     

Right axillary incision: a cosmetically superior approach to repair a wide range of congenital cardiac defects

OBJECTIVES: We sought to evaluate the safety of a right axillary incision, a cosmetically superior approach than anterolateral thoracotomy, to repair various congenital heart defects. METHODS: All the patients who were approached with this incision between March 2001 and October 2004 were included in the study. There were 80 patients (median age, 4 years) with atrial septal defect closure (38 patients), repair of partial abnormal pulmonary venous return (14 patients), partial atrioventricular canal (16 patients), and perimembranous ventricular septal defect (12 patients). The surgical technique involved peripheral and central cannulation for institution of cardiopulmonary bypass. Electrically induced ventricular fibrillation was used for defects located in front of the atrioventricular valves, and cardioplegic arrest was used for those located at the level or behind these valves. RESULTS: The repair was possible without need for conversion to another approach. One patient sustained a transient neurologic deficit. The patients were all in excellent condition after a mean follow-up of 14 months. The cardiac defect was repaired with no residual defect in 75 patients and with trivial residual defect in 5 patients (3 with mitral valve regurgitation, 1 with atrial septal defect, and 1 with ventricular septal defect). The incision healed properly in all, and the thorax showed no deformity. CONCLUSION: The right axillary incision provides a quality of repair for various congenital defects similar to that obtained by using standard surgical approaches. Because it lies more laterally and is hidden by the resting arm, it provides superior cosmetic results compared with conventional incisions, including the anterolateral thoracotomy. Finally, the incision is unlikely to interfere with subsequent development of the breast.