右腋下切口心内直视手术的减创效果观察

目的比较采用右腋下切口完成房间隔缺损、室间隔缺损修补术及二尖瓣替换术与经胸骨正中切口完成相似手术的减创效果。方法回顾分析了23例经右腋下切口进行的房间隔缺损修补、室间隔缺损修补及二尖瓣替换术,及同期经胸骨正中切口进行的26例同类手术。结果两组均无手术死亡,手术时间、体外循环时间、主动脉阻断时间、术后胸液量、术后血红蛋白水平、术后切口并发症及胸腔出血再手术率比较差异无统计学意义。与胸骨正中切口组相比,右腋下切口组术中止血时间,术中术后红细胞及血浆输入量减少,差异有统计学意义。结论经右腋下切口可顺利完成上述心内直视手术,安全有效,与胸骨正中切口相比,可在一定程度上减少手术创伤。

An Analysis on Trauma-Reducing Outcomes of Open Heart Surgery Through Right Axillary Approach

Objective To compare the trauma-reducing outcomes of right axillary incision to the median sternotomy in atrial septal defect（ASD）repair,ventricular septal defect（VSD）repair and mitral valve replacement surgery.Methods A retrospective analysis was made on 23 cases that underwent the repair of ASD or VSD and mitral valve replacement through the right axillary incision,and the outcomes was compared to 26 cases undergoing the similar procedures through the median sternotomy during the same period.Results There was no operative mortality in both groups.No statistical difference was found between the two groups in regard of operation time,bypass time and aortic clamping time,post-operative chest drainage volume,hemoglobin level（Hb）and incidence of incision complications and re-operation for chest bleeding.In right axillary incision group,the hemostasis time during the operation decreased and there was less need in red blood cell and plasma transfusion.Conclusion Right axillary incision is safe and effective for accomplishment of the open heart surgery with fewer traumas to some extent as compared with median sternotomy.