胸骨下段小切口心内直视手术40例

目的介绍胸骨下段小切口心内直视手术体会。方法选择10岁以下房间隔缺损3例、室间隔缺损20例,纵劈胸骨上至第二肋间;10岁以上房间隔缺损5例、室间隔缺损3例、风湿性二尖瓣狭窄9例,纵劈胸骨上至第二肋间并向右侧横断。常规体外循环,胸正中小切口第三胸肋关节水平至剑突根部,完成心内直视手术。结果无手术死亡,平均主动脉阻断时间、体外循环时间、术后24h胸液量与对照组无明显差异。切口长度约为常规胸骨正中切口的60%。结论胸骨下段小切口可以顺利完成部分心内直视手术,美观且保留了胸廓的连续性,无胸骨前凸畸形。

Forty cases of limited lower sternotomy for open heart surgery

Objective To introduce experience of limited lower sternotomy for open heart surgery and report clinicalresults of 40 cases. Methods Sternotomy is the midline incision from the third rib to the base of xiphoid process. Pa-tients under 10 years old underwent sternotomy to the second intercostal space, while patients over ten years old under-went sternotomy to the second intercostal space combining with right transverse cut of sternum. Operations were done byroutine cardiopulmonary bypass (CPB). Results There was no death report. There was also no significant difference inaortic cross- clamp time, CPB time and median blood loss of 24 hours after surgery between lower sternotomy group andcontrol group. The length of incision was about 60% of routine median sternotomy. Conclusion Many open heart surg-eries could be carried out through limited lower sternotomy, which has desirable cosmetic effect, continuity of the tho-racic cage and no pigeon breast formation.