【摘要】 目的　总结右胸前外侧小切口行室间隔缺损修补术的治疗结果及手术经验。方法　右胸前外侧小切口行室间隔缺损修补手术 61例 ,男 3 8例 ,女 2 3例 ,年龄 2 .5～ 2 7岁 ,平均 ( 7.1± 4.8)岁 ,体质量 11～ 71kg ,平均 ( 2 2 .0± 11.6)kg。肺动脉压中度增高 10例。手术在浅低温深度血液稀释体外循环下施行 ,皮肤切口沿右侧第 5肋间长 5～ 8cm ,经第 3或第 4肋间入胸 ,距右膈神经前 2 .0cm纵向切开心包 ,主动脉及上、下腔静脉插管常规建立体外循环。心脏停跳下切开右心房 ,经三尖瓣显露和修补室间隔缺损。结果　 61例患者均痊愈出院 ,皮肤切口长 ( 6.9± 0 .9)cm。体外循环时间 ( 5 7.4±2 1.8)min ,主动脉阻断时间 ( 3 6.2± 14 .8)min ,术后气管插管呼吸机辅助时间 ( 8.5± 5 .8)h ,ICU时间 ( 3 3 .6± 16.9)h ,术后住院 ( 8.2± 1.9)d。术后胸腔引流量 ( 2 0 6.1± 15 0 .7)ml。 5 2例 ( 85 % )未输库血。术后随访 3个月至 4年 ,心功能较术前改善 ,残余分流 2例。结论　采用右胸前外侧小切口技术修补室间隔缺损 ,微创美观 ,安全可靠 ,手术操作简单 ,库血用量小 ,疗效满意。可经三尖瓣修补的室间隔缺损均可采用右胸前外侧小切口术式。更多还原

【Abstract】 Objective To summarize the surgical outcomes and experiences in the repair of ventricular septal defects through a right anterolateral minithoractomy. Methods A total of 61 patients underwent surgical repair for ventricular septal defects through right anterolateral minithoracotomy. There were 38 males and 23 females with an age range of 2.5 to 27 years [mean: (7.1±4.8) years] and their body weight from 11 to 71 kg [mean: (22.0±11.6) kg]. Associated moderate pulmonary hypertension was in 10 cases. The operations were performed with deep hemodilution through cardiopulmonary bypass(CPB) under mild hypothermia. The skin incisions were made in the fifth right intercostal space and limited to 5 to 8 cm. The entry of the chest was in the third or fourth intercostal space. The pericardium was opened anteriorly 2.0 cm to the right phrenic nerve. Standard CPB was established after the canulae were inserted into the ascending aorta and both vena cavae. Repair of ventricular septal defects was done under cardioplegic arrest heart with direct suture or Dacron patch. Results All the patients recovered and were discharged from the hospital. The average length of skin incision was (6.9±0.9) cm. Mean CPB time, aortic cross clamp time were (57.4±21.8) minutes and (36.2±14.8) minutes, respectively. Postoperative mechanical ventilation time, intensive care unit time, and postoperative hospital stay were (8.5±5.8) h, (33.6±16.9) h and (8.2±1.9) d, respectively. The mean volume of postoperative chest drainage was (206.1±150.7) ml. There were 52 patients (85%) who required no homologous blood transfusion. There were 2 residual shunts in all patients during 3 month to 4 year follow up. Conclusion Repair of ventricular septal defects through a right anterolateral minithoractomy is a safe, effective and minimally invasive technique. Cosmetic results are satisfactory. It can minimize homologous blood transfusion and improve postoperative outcome. Transtricuspidal ventricular septal defect repair can be performed with the right anterolateral minithoractomy.更多还原