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目的总结右腋下直小切口在婴儿常见先天性心脏病(先心病)心内直视手术中的应用经验。方法回顾性分析解放军第153中心医院2009年4月至2013年4月采用右腋下直小切口施行婴儿心脏直视手术369例患者的临床资料,其中男191例、女178例,年龄3~12(8.2±3.1)个月,体重4.5~11.2(7.8±4.5)kg。行室间隔缺损(VSD)修补术290例,房间隔缺损(ASD)修补术16例,VSD+ASD修补术34例,VSD修补术+二尖瓣成形术(MVP)4例,肺动脉瓣狭窄(PVS)交界切开术9例,ASD修补术+PVS交界切开术6例,部分肺静脉异位引流(PAPVC)4例和部分房室管畸形(PECD)6例均行手术治疗。结果手术死亡6例(1.6%)。术后发生右肺不张3例,右侧气胸2例,肺部感染16例,切口液化12例,Ⅲ°房室传导阻滞1例,脑气栓1例,二次开胸止血3例。术后6个月至1年门诊随访295例,发现VSD残余漏4例,二尖瓣轻度关闭不全2例。结论在婴儿常见先心病直视手术中,采用右腋下直小切口可获得满意的临床效果,但需要严格把握手术适应证,熟练掌握手术要点。
Objective To summarize the application experience of right axillary straight incision in open heart surgery of common congenital heart disease (CHD) in infants. Methods A retrospective analysis of clinical data of 369 patients undergoing direct open-heart surgery under direct right axil from April 2009 to April 2013 in the 153st Central Hospital of PLA was performed. There were 191 males and 178 females, aged 3 ~ 12 (8.2 ± 3.1) months, body weight 4.5 ~ 11.2 (7.8 ± 4.5) kg. 290 cases of VSD, 16 cases of atrial septal defect (ASD), 34 cases of VSD + ASD, 4 cases of VSD + mitral valvuloplasty (MVP), pulmonary valve stenosis PVS) in 9 cases, ASD repair + PVS in 6 cases, partial pulmonary venous drainage (PAPVC) in 4 cases and partial atrioventricular canal deformity (PECD) in 6 cases. Results of surgery died in 6 cases (1.6%). Postoperative right atelectasis in 3 cases, 2 cases of right pneumothorax, pulmonary infection in 16 cases, incision liquefaction in 12 cases, Ⅲ ° atrioventricular block in 1 case, cerebral infarction in 1 case, secondary thoracotomy in 3 cases . Outpatients were followed up for 295 months from 6 months to 1 year after surgery. Four cases of residual VSD leakage and 2 cases of mild mitral regurgitation were found. Conclusion In the common CHD surgery in infants, the direct use of right axillary straight incision can achieve satisfactory clinical results, but the need to strictly grasp the indications for surgery, master the essentials of surgery.