右腋下小切口行心内直视手术临床效果分析

目的探讨右腋下小切口行心内直视手术临床效果及注意事项。方法选择心脏病患者80例作为研究对象，随机分为观察组及对照组各40例，观察组实施右腋下小切口行心内直视手术，对照组进行正中切口手术。结果无早期死亡，两组并发症发生率比较差异无统计学意义（P〉0．05），均未出现膈神经麻痹、二次开胸、切口感染及严重肺部并发症。两组体外循环时间及主动脉阻断时间差异无统计学意义（P〉0．05）；观察组关胸时间、ICU停留时间、胸腔引流量及术后住院时间等显著少于对照组，差异有统计学意义（P〈0．05）。结论右腋下小切口行心内直视手术具有出血少、创伤小、美容效果好等优点，值得进一步的推广和应用，需要熟练的心外手术操作技巧，严格掌握适应证。

Analysis on clinical effect of small right subaxillary incision for intracardiac surgery under direct vision.

Objective To explore the clinical effect of intracardiac surgery under direct vision through small right subaxillary incision and points needed to pay attention. Methods Eighty patients with heart diseases were randomly and averagely assigned to receive operation through small right subaxillary incision （trial group） or to receive conventional operation through median stertlotomy （ control group）. Results There was no statistically significant differeuce with complications （ P 〉 0.05 ） and no early death occurred. Patients showed no paralysis of phrenic nerve, second time operation, serious pulmonary complications, incisional infection or residual shunts. There was no statistically significant difference in duration for cardiopulmonary bypass and aortic occlusion （ P 〉0.05）. The time for suturing sternum, duration of staying in ICU and staying in hospital after operation in trial group were obviously lesser than those of control group （ P 〈 0.05）. Patients in trial group had less chest drainage （ P 〈 0 05）. Conclusion The way for intracardiac surgery under direct vision through small right subaxillary incision causes less hemorrhage and trauma. It has a better esthetic effect but it should be safely and accurately operated.