右腋下小切口心脏不停跳修补房间隔缺损的临床经验

目的 总结经右腋下直切口行体外循环直视、心脏不停跳下房间隔缺损修补手术的临床经验，探讨其适应证及技术要点。 方法 2011年1月至2016年12月我们共完成92例经右腋下直切口的体外循环心脏直视手术，其中男52例、女40例，患者年龄12个月至28岁，平均(5.2±3.3)岁，体重8.5～52.0(17.9±8.6)kg。其中2例合并部分型肺静脉异位引流，6例存在中度以上肺高压，同期行三尖瓣成形39例。所有手术均在全身麻醉、体外循环心脏不停跳下进行。患者取左侧卧位，切口位于腋中线与腋前线之间，皮肤切口长度约5～8cm，约经第3或第4肋间进胸，切开并悬吊心包，行升主动脉及上、下腔静脉插管建立体外循环，经右心房切口修补房间隔缺损及三尖瓣成形。结果 全组手术均顺利完成，无手术死亡；术中无恶性心律失常和气栓发生，术后无脑部并发症，2例术后出现少量气胸、皮下气肿，1例出现肺不张，1例随访有1～2mm残余分流。结论 右腋下小切口心脏不停跳下心内修补房间隔缺损手术具有安全、可靠，美容效果好、创伤轻、手术时间短以及术后恢复快等优点，患者及家属满意率高，值得临床推广。

Clinical experience of atrial septal defect repair by right subaxillary small incision beating heart

Objective Objective to summarize the clinical experience of atrial septal defect repair by right subaxillary straight incision under cardiopulmonary bypass and beating heart, and to explore its indications and technical points. Methods From January 2011 to December 2016, we completed a total of 92 cases with right subaxillary incision open heart surgery, including 52 cases of male, female 40 cases, age 12 months to 28 years old, the average (5.2 + 3.3) years old, weighing 8.5 ~ 52 (17.9 + 8.6) kg. Among them, 2 cases complicated with partial anomalous pulmonary venous drainage, 6 cases with moderate or higher pulmonary hypertension, and 39 cases underwent three tricuspid valvuloplasty at the same time. All operations were performed under general anesthesia, cardiopulmonary bypass, and beating heart. Patients take the left decubitus, the incision in the axillary midline and the anterior axillary line, skin incision length is about 5 ~ 8cm, after about third or fourth intercostal incision and pericardial suspension, ascending aorta and extracorporeal circulation, inferior vena cava intubation through the right atrial incision repair of atrial septal defect and three tricuspid valve repair.Results All groups were successfully completed surgery, no surgical death; no malignant arrhythmia and thrombosis in patients without brain, postoperative complications, pneumothorax and subcutaneous emphysema occurred in 2 cases, 1 cases of atelectasis, 1 cases were followed up for 1 ~ 2mm residual shunt. Conclusion Right subaxillary small incision in beating heart repair of atrial septal defect surgery is safe, reliable, good cosmetic effect, less trauma, shorter operative time and postoperative recovery fast, patient and family satisfaction rate is high, it is worthy of clinical promotion.