右腋下小切口剖胸矫治5公斤以下婴儿室间隔缺损

目的:探讨右腋下小切口剖胸心内直视手术矫治5 kg以下婴儿室间隔缺损的安全性和手术效果。方法:与正中切口手术的病例(正中组,n=113)比较,分析右腋下小切口剖胸(右侧组,n=85)矫治婴儿室间隔缺损的效果,评价指标包括:术前资料、围术期指标、术后病死率及并发症。结果:两组病例大多术前指标差异无统计学意义(P0.05),仅正中组体质量(4.61±0.41)vs.(4.95±1.18)kg,P0.05]、体表面积(0.27±0.02)vs.(0.28±0.01)m2,P0.05]、术前有肺炎史的病例所占比例(44.2%vs.64.7%,P0.05)低于右侧组。右侧组手术切口小于正中组(6.01±0.85)vs.(9.13±1.04)cm,P0.05],手术时间(143.64±22.41)vs.(152.12±22.80)min,P0.05]、术后住院时间较正中组短(7.13±2.60)vs.(8.86±3.67)d,P0.05],引流量14.6(12,16)vs.16.4(13,20)mL/kg,P0.05]和输血量10(0,20)vs.11.1(0,20)mL/kg,P0.05]也较正中组少,两组其他围术期指标类似(P0.05)。结论:右腋下小切口剖胸心内直视手术矫治婴儿室间隔缺损病例的效果确切、可靠。

The application of minimally invasive open heart surgery through right subaxillary shorter incision for ventricular septal defects in infants weighted less than 5kg

Objective：To explore the safety and outcome of minimally invasive open heart surgery for ventrieular septal defects （VSD） in infants with low body weight. Methods： Eighty five infants weighted less than 5 kg who had undergone repair of VSD through a fight subaxillary short incision were surveyed （ right group） and 113 patients with similar weight were surveyed who had undergone the repair of VSD through a me- dian sternotomy （median group）. Preoperative data, perioperative parameters, mortality and morbility were in- vestigated for retrospective analysis. Results： Most of the preoperative data in right group and median group were similar（P 〉0. 05） except that the body weight, I （4. 61±0.41 ） vs. （4. 95±1.18） kg,P 〈0.05）], body surface area E （0- 27 ± 0.02） vs. （0. 28 ± 0. 01 ） m2, P 〈 0. 05 ], the incidence of preoperative pneumo nia history （44.2% vs. 64.7 % , P 〈 0.05 ） in median group were lower than that of right group （ P 〈 0. 05 ）. Compared with median group, fight group was with shorter incision （6.01±0. 85） vs. （9.13 ± 1.04） cm,P 〈0. 05 ], length of operative time （ 143.64 ± 22.41 ） vs. （ 152. 12 ± 22. 80） min,P 〈 0. 05 ] and postopera- tive stay （7.13 ±2. 60） vs. （8.86 ±3.67） d,P〈0. 051, and less drainage 14. 6（12,16） vs. 16.4（13, 20 ） mL/kg, P 〈 0. 051 and transfusion of red blood cell 10 （0,20） vs. 11.1 （ 0,20 ） mL/kg, P 〈 0. 05 ]. There were no deaths and low incidence of complications in both groups, and without significant difference betweenthem （P 〉 0.05）. Conclusion： The minimally invasive open heart surgery through right subaxillary short inci- sion for VSD in infants with low body weight was safe and effective.