右腋下小切口入路手术与胸骨正中切口手术治疗先天性心脏病患儿的效果比较

目的 对比右腋下小切口入路手术与胸骨正中切口手术治疗先天性心脏病(CHD)患儿的临床效果.方法 选取2018年10月至2020年10月我院收治的90例CHD患儿,随机分为观察组(n=45)与对照组(n=45).观察组行右腋下小切口入路手术治疗,对照组行胸骨正中切口手术治疗,比较两组的临床指标及术后不同时间点的气道峰压(...     

微创右腋下小切口心脏不停跳治疗先天性心脏病

目的　总结先天性心脏病的微创治疗经验。方法　自 1999年 10月～ 2 0 0 2年 12月 ,采用微创右腋下小切口 ,在常温体外循环心脏不停跳下行心内直视手术治疗先天性心脏病 3 5例 ,其中房间隔缺损 2 1例 ,室间隔缺损 12例 ,法洛三联征 2例。结果　全组无一例死亡 ,均治愈。结论　微创治疗先天性心脏病安全 ,暴露好 ,手术失血少 ,时间短 ,损伤轻 ,术后病人痛苦小 ,恢复快 ,切口隐蔽 ,美观     

右侧腋下直切口治疗小儿先天性心脏病303例体会

目的总结经右侧腋下直切口治疗小儿先天性心脏病303例的体会。方法2006年1月至2009年6月,经右侧腋下直切口,第3、4肋间进胸体外循环下治疗小儿先天性心脏病303例,患儿年龄（3．02±1．35）（7个月至6岁）岁,体重（14．24±2＋39）（6～35）kg,其中室间隔缺损（VSD）106例,房问隔缺损（ASD）94例,法洛四联症（TOF）35例,右室流出道狭窄（RVOTO）21例,部分型心内膜垫缺损（PECD）11例,二尖瓣关闭不全（MI）15例,部分性肺静脉异位引流（PAPVC）21例。结果术后1例死亡,死因为低心排。其余患儿经治疗后康复出院,术后发生并发症16例,其中室间隔缺损术后残余分流2例,右肺膨胀不全8例,肺部感染5例,右膈神经麻痹1例。结论右侧腋下直切口在治疗某些小儿先天性心脏病效果满意,安全性高,不破坏胸骨连续性,胸骨畸形发生率低,瘢痕隐蔽,美观,效果良好。     

胸骨下段小切口治疗小儿先心病的临床分析

目的:介绍胸骨下段小切口行小儿心内直视手术的体会。方法:观察组选择35例先天性心脏病患儿,经胸骨下段小切口进胸,完成心内直视手术。患儿年龄6月~5岁,修补室间隔缺损(VSD)23例,房间隔缺损(ASD)8例,肺动脉瓣狭窄(PS)4例。对照组随机抽取年龄、体重及病种与观察组相仿的患儿32例作为对照,均经常规胸骨正中切口,完成心内直视手术。结果:两组相比,体外循环时间、术后呼吸机辅助时间、术后引流量及术后住院天数差异无显著性(P>0.05),而切口长度差异有显著性,观察组明显短于对照组(P<0.05)。结论:胸骨下段小切口可有效代替常规胸骨正中切口,矫治某些小儿常见先天性心脏畸形。它具有创伤小、美观、无胸骨前凸畸形。     

心脏病的微创伤手术

沈阳军区总医院心血管外科已对500余例心脏病患者施行微创伤切口手术,病人术后创伤小,恢复快。心脏病的微创伤手术系指手术入径切口长度为6—10cm,切口可位于一侧腋下、胸骨中下段、胸骨左或右缘或一侧胸前区。而其中的右腋下直切口,则以隐蔽性好、美容效果佳、手术操作容...     

微创小切口心脏手术与常规切口的对比研究

目的 探讨心脏手术不同入路的创伤、疗效和预后,以指导临床.方法 对41例动脉导管未闭患者行左腋下小切口(A组);46例房间隔缺损、室间隔缺损、法洛三联症患者行右腋下小切口(C组);49例瓣膜置换、室间隔缺损、房间隔缺损、法洛四联症、左心房黏液瘤患者行胸骨下段小切口(D组);与常规左胸后外侧切口42例(B组)及胸骨正中切口77例(E组)进行对比观察.结果 (1)A组手术时间(38±13)min、出血量(17±12)ml、住院天数(6±2)d,与B组[分别为(64±14)min、(200±100)ml、(11±3)d]比较差异均有统计学意义(P<0.01).(2)C组体外循环时间(39±8)min、出血量(150±150)ml、住院天数(8±3)d,与E组[分别为(68±8)min、(700±300)ml、(12±4)d]比较差异均有统计学意义(P<0.01或<0.05).D组出血量、引流量与E组比较差异有统计学意义(P<0.05).结论 左腋下小切口、右腋下小切口、胸骨下段小切口手术具有切口小、出血少、创伤小、疼痛轻、胸廓稳定、恢复快、住院天数少、切口隐蔽等优点.     

右腋下斜切口心脏不停跳治疗先天性心脏病

随着心血管手术的安全性不断提高 ,术后美观问题日益受到人们重视 ,小切口、微创手术应运而生 ,切口可位于一侧腋下 ,胸骨下段 ,胸骨右缘等 ,我们采用右腋下斜切口 ,长约 5～ 8ｃｍ[1] ,在心脏不停跳下行心内直视手术 ,经实践有安全性高、暴露满意、隐蔽性好 ,美容效果好等优点 ,现总结如下。1　资料与方法1·1　临床资料　本组 30例病人 ,年龄 2～ 6 3岁 ,术前经心电图、心脏三相片、心脏彩超检查。诊断均经手术证实 ,其中单纯二孔型房缺 18例 ,室间隔缺损 10例 ,法乐氏三联症 2例。1·2　手术方法　全部手术在全身麻醉及体外循环下完成 ,…     

小儿心内术右腋下微创小切口与胸部正中切口对比

目的：通过对两种切口术后胸腔引流量和住院天数的比较,观察先天性心脏病患儿经右腋下小切口剖胸体外循环下行心内直视手术的疗效。方法：A组19例患者采用右腋下微创小切口,B组25例同期采用正中剖胸入路行心内直视术,术后均给予胸腔及心包、纵隔引流管的常规护理。结果：A组与B组的患者相比,胸腔引流量分别为A组平均130ml;B组平均448ml;术后住院天数平均9.8d、14.2d,差异有显著性（P〈0.01）。结论：右腋下微创小切口剖胸治疗小儿先天性心脏病较常规正中剖胸入路可减少术后胸腔引流量和术后住院天数。     

右腋下小切口先天性心脏病手术42例患儿围术期护理方案探讨

目的分析并评价右腋下小切口先天性心脏病手术患儿的围术期护理方案。方法随机将84例手术患儿分成两组,其中对照组42例患儿实施常规护理,观察组42例在对照组护理基础上给予健康宣教与心理护理,对比分析两组在术后并发症、呼吸机辅助时间、胸液引流量以及住院天数方面的差异。结果两组患儿均顺利实施手术,未见死亡病例。观察组患儿术后疼痛、肺不张及肺部感染的发生率显著低于对照组(P<0.05),存在统计学意义;观察组患儿的呼吸机辅助时间、胸液引流量以及住院天数均显著少于对照组(P<0.05),存在统计学意义。结论对右腋下小切口先天性心脏病手术患儿与家长实施临床护理,给予健康宣教以及心理护理,能够提升临床护理质量,保证手术安全,提倡临床推广应用。     

腋下小纵切口开胸手术42例

目的探讨腋下小纵切口开胸手术的效果。方法回顾性分析42例行腋下小纵切口开胸术患者的临床资料。结果42例全部治愈,1例因肥胖切口脂肪液化,伤口延期愈合。1例术后半月复查胸片,见右上胸残留气胸30%,经胸穿抽气,抗炎治疗治愈。结论腋下小纵切口开胸手术开关胸时间短,术中出血和术后引流量少,切口隐蔽、美观,术后疼痛轻,并发症少,恢复快,住院时间明显减少,可在缺乏胸腔镜技术的基层医院广泛使用。     

Right subaxillary and posterolateral thoracotomy for open repair of congenital heart defects

OBJECTIVE: Low-risk cardiac surgery approaches zero morbidity/mortality, therefore, cosmetic issues append. Right thoracotomy has been advocated as cosmetically attractive alternative to median sternotomy. Posterolateral thoracotomy involves chest wall musculature division that contributes to postoperative pain/morbidity; access to the heart may be difficult. Longitudinal subaxillary incision and muscle-sparing thoracotomy can overcome these disadvantages and provide better visibility. PATIENTS AND METHODS: Between April 2000 and April 2004 the authors performed open-heart repair from right thoracotomy in 161 patients. Diagnoses comprised perioval and sinus venosus ASDs (137), VSD (11), incomplete/intermediate AVD (8), miscellaneae (5). According to both patients' and surgeon's preference a longitudinal midaxillary incision and muscle-sparing lateral thoracotomy was utilised in 98 cases. Intracardiac repair was performed by extracorporal circulation, usual cannnulation, cardioplegia. Data of 79 ASD closures via midline sternotomy were used as controls. RESULTS: Sternotomy and thoracotomy groups did not differ in demographic characteristics albeit thoracotomies exhibited wider age and weight range. The skin incision could be easily stretched up by 60% providing excellent visibility/access. No mortality occurred. Phrenic nerve palsies (2), transient tetraparesis (1) fully recovered. A mitral valve replacement was necessary for valve pathology unrelated to access. No breast and/or upper limb vascular/neurologic problems were encountered. CONCLUSIONS: Right subaxillary muscle-sparing thoracotomy offers safe option for open-heart repair of selected anomalies. Despite the shorter skin incision subaxillary approach provides better visibility than conventional thoracotomy as mediastinal organs are closer to the operator. Intermediate cosmetic result are appealing. With no muscles divided less postoperative pain is anticipated. The authors recommend to expand the spectrum of anomalies repaired via this approach.     

经右腋下直切口房室间隔缺损手术

目的:总结22例病人,年龄4～35岁,经右腋下直切口行房室间隔缺损心内手术体外循环经验.方法:所有病人经右腋下直切口完成修补术.结果:无手术并发症和死亡,均痊愈出院.结论:单纯房室间隔缺损病人经右腋下直切口体外循环心内手术是一种微创、美观的手术方法.     

右腋下小切口行心内直视手术26例

目的:总结右腋下小切口行心内直视手术治疗体会。方法:回顾分析了26例经右腋下小切口行心内直视手术的临床资料,切口取右腋中线与第3肋的交点为上缘,腋中线与第6肋的交点为下缘,经第4或第3肋间入胸,其中房间隔缺损15例、室间隔缺损10例、二尖瓣置换 右肺中叶切除1例。结果:全组26例手术顺利,无严重并发症;其中二尖瓣置换 右肺中叶切除的患者,并同行三尖瓣DeVega环缩,术后出现高热,抗炎治疗1月后治愈。结论:经右腋下小切口径路行心内直视手术,是一种安全、有效、美观的手术方式,具有损伤小,瘢痕隐蔽,不破坏胸廓完整性,出血少,恢复快等优点,符合微创外科的原则。     

微创切口小儿心内直视手术56例临床分析

目的 报告一组小儿先天性心脏病采用微创切口手术治疗的经验。方法 全组56例病儿中继发孔房间隔缺损（ASD）25例,室间隔缺损（VSD）26例,右室双腔心（DCRV）2例,肺动脉狭窄（PS）3例。右前外侧小切口不停跳、不阻断主动脉心内直视手术23例,胸部正中小切口33例。结果 除1例因术中显露差改作常规切口,全组56例无手术死亡,无严重并发症。病儿术后恢复快,平均住院时间8d。结论 微创切口小儿心内直视手术创新小、美观、痛苦少、恢复快、住院时间短、安全有效,尤其适应于继发孔房缺及膜部或膜周室缺修补手术。     

先天性心脏病患者人工流产镇痛的应用分析

目的:总结分析先天性心脏病患者应用骶前孔阻滞行人工流产镇痛的效果。方法:选取接受人工流产术的先天性心脏病患者65例,随机分为骶前孔阻滞组(n=35)和对照组(n=30)。监测各组麻醉范围、双下肢皮温、肛温、血压、呼吸、心率、血氧饱和度、临床效果及手术中VAS评分变化。结果:骶前孔阻滞麻醉范围及皮温变化涉及臀中神经、臀下神经、阴部神经、股后皮神经、坐骨神经分布区。手术前后血压、呼吸、心率、血氧饱和度无显著变化,VAS评分显著低于对照组(P<0.01)。结论:骶前孔阻滞操作简便,效果肯定,可作为人工流产镇痛的可选途径。     

胸腔镜辅助腋下小切口治疗肺大疱合并自发性气胸的临床研究(附37例报道)

目的探讨胸腔镜辅助腋下小切口治疗肺大疱合并自发性气胸的方法及疗效。方法回顾性分析37例肺大疱合并自发性气胸患者行胸腔镜联合小切口治疗的临床资料。结果本组37例患者病肺均一次手术获治愈,至今随访无胸腔感染,脓胸等严重并发症,无再次开胸,无死亡,无复发。结论本方法具有创伤小、术后恢复快等优点,对特殊设备要求低,在无胸腔镜设备的医院可选用腹腔镜代替开展。     

Adult congenital heart program in a tertiary care facility of pediatric cardiology

INTRODUCTION: Owing to excellent survival following primary repair over 80% of congenital cardiac patients reach adulthood, half of them requiring continuous specialist care and one-third needing further reoperation. The ample variety and complexity of lesions warrant individualised treatment strategy. OBJECTIVE: This study focuses on grown-up congential heart (GUCH) programme in the settings of a tertiary pediatric cardiac centre. METHODS: Patients underwent corrective surgical procedures in pediatric facilities (theatre, ICU, wards) with a close involvement of adult cardiology/anaesthetic team. Patients were divided into simple/complex groups. RESULTS: Simple group of comprised patients (n = 20) having ASD-II (18/20) sinus venosus ASD (2/20) repair without morbidity/mortality from right subaxillary thoracotomy in 17/20. Complex group (n = 20): corrective surgery for tetralogy of Fallot (6), LVOT-aortic valve repairs (4), allograft conduit exchange (3), TCPC (3), miscellaneous procedures (4) were performed as reoperations in 16/20 at 16.1 +/- 8.1 years following previous operations (median: 1.96, range 1-4). Postoperative right ventricle- (1), acute renal (1) failure and ARDS (1) fully recovered. One patient was lost for multi-organ-failure due to low cardiac output syndrome caused by chronic RV failure. Preoperative cyanosis was a risk factor for postoperative complications (p = 0.01). All survivors are symptom-free. No significant difference in ITU stay/LOS was observed between simple and complex groups. CONCLUSIONS: This study represents the initial experience of authors with GUCH. The number of GUCH patients is expected to rise with an upgrade shift in surgical complexity and severity requiring a multidisciplinary approach. It is advocated that complex GUCH cases should be performed by teams experienced in congenital reconstructive surgery. Patients following complex GUCH procedures have a comparable hospital course to patients undergoing simple cardiac operations.