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Title:: Clinical application of right vertical axillary incision for simple congenital heart disease in children

作者:: 马涛¹; 万军²; 于浩¹; 董文鹏¹; 王晓武¹; 袁彬彬¹; 张卫达¹; (1.广州军区广州总医院心胸外科，广东广州 510010；
2.解放军第458医院检验科，广东广州 510610)

Author(s):: MA Tao¹; WAN Jun²; YU Hao¹; DONG Wen peng¹; WANG Xiao wu¹; YUAN Bin bin¹; ZHANG Wei da¹; (1.Department of Cardiovascular Surgery, Guangzhou General Hospital, Guangzhou Military Area Command, Guangzhou 510010, Guangdong, China;
2.Clinical Laboratory, PLA 458 Hospital, Guangzhou 510610, Guangdong, China)

关键词:: 先天性心脏病; 切口选择; 未成年人

Keywords:: congenital heart disease; right vertical axillary incision; children

分类号:: R541.1

DOI:: -

文献标识码:: A

摘要:: 目的:总结和分析我科在右腋下纵行直切口体外循环下，矫治房间隔缺损、室间隔缺损及肺动脉瓣狭窄未成年患者的临床资料，并对该径路的优缺点进行评价。方法:回顾性分析我科2011年1月~2012年10月，经右腋下纵行直切口治疗的280例未成年先天性心脏病(CHD)患者的临床资料，包括：体外循环时间、主动脉阻断时间和主要并发症。结果:280例全部手术患者体外循环时间平均为5235 min，主动脉阻断时间为22.36 min，无死亡及其它严重并发症，但术后80例有不同的并发症：心包积液19例、心包积气2例、右下肺感染27例、右肺感染2例、双肺感染1例、右侧胸膜增厚及黏连1例、右侧气液胸（胸腔积液）11例、伴肺组织压缩3例、右侧气胸4例、右上叶不张3例、右侧胸壁皮下气肿2例、左侧胸腔积液3例、双侧胸腔积液1例及右侧肋骨骨折伴胸腔积液1例。结论:采用右腋下纵行直切口径路治疗CHD具有创伤小、出血少、关胸快，术后胸腔及心包引流量少、胸廓稳定性好、可避免术后胸骨裂开、鸡胸等并发症及美观效果好等优点。在充分判断患者体质量、年龄的基础上明确诊断，并可预见性地预防术后相关肺部并发症的发生，值得广泛应用。

Abstract:: AIM:To evaluate the advantages and disadvantages of right vertical axillary incision for correction of atrial septal defect (ASD), ventricular septal defect (VSD) and pulmonary stenosis (PS) by analyzing the clinical data of patients with ASD, VSD or PS. METHODS: In this single-centered retrospective study, clinical data were collected and retrospectively analyzed in 280 patients <18 years of age who underwent surgery of the right vertical axillary incision for correction of congenital heart disease from January 2011 to October 2012. Cardiopulmonary bypass time, aortic cross-clamp time and primary complications were examined. RESULTS: All operations were successful without serious complications and no operative deaths occurred. The average time of extracorporeal circulation and aorta blocking time was 52.35 min and 22.36 min, respectively. Complications included pericardial effusion (19 cases), pericardial pneumatosis (two cases), right lower lung infection (27 cases), right lung infection (two cases), double lung infection (one case), right pleural thickening and adhesion (one case), right gas-liquid chest (11 cases) with lung compression (three cases), right side pneumothorax (four cases), right upper lobe collapse (three cases), subcutaneous emphysema of right chest wall (two cases), left-sided pleural effusion (three cases), bilateral pleural effusion (one case), right lateral rib fractures and pleural effusion (one case). CONCLUSION: Minithoracotomy, less hemorrhage, quick recovery and concealed incision are some advantages of right vertical straight incision. Application of right vertical axillary incision should be based on proper consideration of the patients’ weight and age, correct diagnosis, and anticipation and prevention of postoperative pulmonary complications.

参考文献/References

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右腋下纵行直切口在未成年先天性心脏病患者手术中的临床应用

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

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