右腋下小纵切口行心脏直视手术152例

目的:介绍右腋下小纵切口行各种心脏手术经验。方法:经右腋下腋中线第3肋间至腋前线第6肋间纵行切口开胸。行房间隔缺损修补73例,室间隔缺损修补49例,肺动脉瓣狭窄成形16例,部分型心内膜垫缺损矫治术8例,左房黏液瘤切除3例,二尖瓣置换手术3例。其中38例房间隔缺损,11例室间隔缺损,2例左房黏液瘤,6例部分型心内膜垫缺损是在不停跳体外循环下进行的。结果:全组无死亡,1例下腔静脉破裂,1例肋间血管出血,2例肺不张,气胸、右胸腔积液各3例,1例VSD术后出现残余漏,经处理均痊愈出院。结论:常见的心脏疾患采用右腋下小纵切口可以替代正中切口,具有切口隐蔽,不破坏胸廓完整性,防止术后鸡胸,消除成年后心理障碍等优点。

Cardiac Operation Via Direct Vision From Right Subaxillary Small Incision (Report of 152 Cases)

Objective:To introduce the experience of cardiac operation through the right subaxillary small incision.Methods:The intersection of right posterior axillary line and the third posterior ribwas taken as the posterior upper margin of incision,and that of the anterior axillaryline and the sixth rib as the anterior lower margin.Between two points,incision was made to enter the chest at the 6th intercostal space.The cardiac operations were performed in 67 atrial septal defect(ASD),49 ventricular septal defect(VSD),16 pulmonary stenosis(PS),8 partly endocardial cushion defect(PECD),3 left atrial myoxoma(LAM) and 3 mitral valve replacement(MVR).38 ASD,11 VSD,2 LAM and 6 PECD were performed with extracorporeal ciculation bypass.Results:There were 0 case death,1 rupture in inferior vena cava,1 hemorrhage in intercostal blood vessel,2 pulmonary atelectasis,3 pneumothorax,3 pleural effussion and 1 remnant leakage after VSD operation.All cases recovered after management.Conclusions:Common cardiac surgery may adopt right subaxillary small incision instead of medial incision,with obsolete incision,protecting intact thoracic case from pigeon chest and eliminating adult mental disorder.