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目的右腋下小切口手术治疗先天性心脏病法洛四联症可行性。方法 79例法洛四联症患儿,采用右腋下小切口在体外循环下行心内直视手术,术前均行心脏彩超检查,其中单纯法络四联症35例,法络四联症合并其他畸形44例,本组均在全身麻醉低温体外循环下行法洛四联症根治术,观察手术结果。结果本组患儿手术平均时间(65.9±11.4)min,术后胸腔引流管一般在2~5 d拔除。全组死亡1例,因左心发育不良、术后低心排死亡。二次开胸止血1例,右侧气胸5例,合并肺炎4例,切口愈合不良2例,清创缝合,均经治疗后痊愈出院。随访3~36个月,78例恢复良好,切口愈合良好,瘢痕较小,无胸骨畸形,复查心脏彩超情况均较好。结论右腋下小切口可完成法洛四联症手术治疗,不但创伤小、恢复快、切口美观,也是较安全的手术方法 ,值得推广。
The purpose of the right axillary small incision surgery for the treatment of tetralogy of Fallot in patients with congenital heart disease feasibility. Methods 79 cases of tetralogy of Fallot with right axillary small incision under cardiopulmonary bypass under direct open surgery, preoperative cardiac echocardiography, including simple method of complex quadruple disease in 35 cases, Combined with other malformations in 44 cases, this group are under general anesthesia hypothermia cardiopulmonary bypass tetralogy of Fallot approach to observe the surgical results. Results The average time of operation in this group was (65.9 ± 11.4) min, and the drainage tube of the chest was generally removed after 2 ~ 5 d. One case of death in the whole group, due to left heart dysplasia, low cardiac output after death. One case of secondary thoracotomy, pneumothorax on the right in 5 cases, 4 cases of pneumonia, incision poor healing in 2 cases, debridement and sutured, were cured after treatment and discharged. During the follow-up of 3 to 36 months, 78 cases recovered well, the incision healed well, the scar was smaller, the sternum without deformity was found, and the situation of cardiac ultrasonography was better. Conclusion The right axillary small incision can complete the tetralogy of Fallot surgical treatment, not only trauma, rapid recovery, good incision, but also a safer surgical approach, it is worth promoting.