• 第三軍醫(yī)大學(xué)大坪醫(yī)院野戰(zhàn)外科研究所 心血管外科,重慶 400042;

目的 總結(jié)右側(cè)腋下小切口心臟直視手術(shù)臨床應(yīng)用的經(jīng)驗(yàn)?!》椒ā』仡櫺苑治?010年5月至2011年8月大坪醫(yī)院采用右側(cè)腋下小切口施行心臟直視手術(shù)83例先天性心臟病患者的臨床資料,其中男27例,女56例;年齡7個月~59 (8.0±9.1)歲;行房間隔缺損修補(bǔ)術(shù)21例(心臟不停跳18例、同期行三尖瓣成形術(shù)3例、二尖瓣成形術(shù)1例),行室間隔缺損修補(bǔ)術(shù)60例(同期行右心室流出道疏通術(shù)4例),完全性肺靜脈異位引流矯治術(shù)1例,右心室雙出口矯治術(shù)1例。 結(jié)果 全組患者均順利完成手術(shù),體外循環(huán)時間21 ~ 185 (66.9±32.3) min,升主動脈阻斷時間5 ~ 122 (32.5±25.5) min。 早期死亡1例(1.2%),死亡原因?yàn)榈托呐叛俊iT診隨訪80例,失訪3例。無殘余漏、Ⅲ○房室傳導(dǎo)阻滯等并發(fā)癥發(fā)生?!〗Y(jié)論 右側(cè)腋下小切口選擇性應(yīng)用于先天性心臟病直視手術(shù),安全可靠、創(chuàng)傷小,切口美觀;但應(yīng)強(qiáng)調(diào)適應(yīng)證的合理選擇、充分的術(shù)野顯露、可靠的體外循環(huán)以及術(shù)中準(zhǔn)確的手術(shù)操作。

引用本文: 胡義杰,鐘前進(jìn),陳建明,李志平,沈誠,宋毅,廖祥麗,趙孝英,范士志. 右側(cè)腋下小切口先天性心臟病直視手術(shù)的臨床應(yīng)用. 中國胸心血管外科臨床雜志, 2012, 19(4): 427-429. doi: 復(fù)制

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2.  Nguyen K, Chin C, Lee DS, et al. The axillary incision:a cosmetic approach in congenital cardiac surgery. J Thorac Cardiovasc Surg, 2007, 134 (5):1358-1360.
3.  Prêtre R, Kadner A, Dave H, et al. Right axillary incision:a cosmetically superior approach to repair a wide range of congenital cardiac defects. J Thorac Cardiovasc Surg, 2005, 130 (2):277-281.
4.  Tünerir B, Aslan R. An alternative, less invasive approach to median sternotomy for cardiac operations in adults:right infra-axillary minithoracotomy. J Int Med Res, 2005, 33 (1):77-83.
5.  胡盛壽, 主編. 臨床微創(chuàng)心臟外科技術(shù). 合肥:安徽科學(xué)技術(shù)出版社, 2005. 207-213.
6.  何發(fā)明, 王平凡, 梁志強(qiáng), 等. 右腋下小切口心臟直視手術(shù)3012例的臨床應(yīng)用. 中國胸心血管外科臨床雜志, 2010, 17 (3):247-249.
7.  馮曉東, 張勇, 王學(xué)斌, 等. 腋下直切口在體外循環(huán)心臟直視手術(shù)中的應(yīng)用:附612例報(bào)告. 中國微創(chuàng)外科雜志, 2009, 9 (7):632-634.
8.  王東進(jìn), 吳清玉, 楊秀濱, 等. 右腋下直切口在體外循環(huán)心臟直視手術(shù)中的應(yīng)用. 中國胸心血管外科臨床雜志, 2007, 14 (6):468-470.
9.  Yang X, Wang D, Wu Q. Repair of atrial septal defect through a minimal right vertical infra-axillary thoracotomy in a beating heart. Ann Thorac Surg, 2001, 71 (6):2053-2054.
10.  王東進(jìn), 賈朝相, 曹彬, 等. 右腋下縱形小切口行心臟瓣膜手術(shù)臨床觀察. 中國醫(yī)師雜志, 2004, 6 (8):1066-1067.
11.  Gil-Jaurena JM, Ji ZL, Conejo L, et al. Minimally invasive pediatric cardiac surgery. Atrial septal defect closure through axillary and submammary approaches.Rev Esp Cardiol, 2011, 64 (3):208-212.
12.  Dave HH, Comber M, Solinger T, et al. Mid-term results of right axillary incision for the repair of a wide range of congenital cardiac defects. Eur J Cardiothorac Surg, 2009, 35 (5):864-869.
  1. 1.  del Nido PJ. Minimal incision congenital cardiac surgery. Semin Thorac Cardiovasc Surg, 2007, 19 (4):319-324.
  2. 2.  Nguyen K, Chin C, Lee DS, et al. The axillary incision:a cosmetic approach in congenital cardiac surgery. J Thorac Cardiovasc Surg, 2007, 134 (5):1358-1360.
  3. 3.  Prêtre R, Kadner A, Dave H, et al. Right axillary incision:a cosmetically superior approach to repair a wide range of congenital cardiac defects. J Thorac Cardiovasc Surg, 2005, 130 (2):277-281.
  4. 4.  Tünerir B, Aslan R. An alternative, less invasive approach to median sternotomy for cardiac operations in adults:right infra-axillary minithoracotomy. J Int Med Res, 2005, 33 (1):77-83.
  5. 5.  胡盛壽, 主編. 臨床微創(chuàng)心臟外科技術(shù). 合肥:安徽科學(xué)技術(shù)出版社, 2005. 207-213.
  6. 6.  何發(fā)明, 王平凡, 梁志強(qiáng), 等. 右腋下小切口心臟直視手術(shù)3012例的臨床應(yīng)用. 中國胸心血管外科臨床雜志, 2010, 17 (3):247-249.
  7. 7.  馮曉東, 張勇, 王學(xué)斌, 等. 腋下直切口在體外循環(huán)心臟直視手術(shù)中的應(yīng)用:附612例報(bào)告. 中國微創(chuàng)外科雜志, 2009, 9 (7):632-634.
  8. 8.  王東進(jìn), 吳清玉, 楊秀濱, 等. 右腋下直切口在體外循環(huán)心臟直視手術(shù)中的應(yīng)用. 中國胸心血管外科臨床雜志, 2007, 14 (6):468-470.
  9. 9.  Yang X, Wang D, Wu Q. Repair of atrial septal defect through a minimal right vertical infra-axillary thoracotomy in a beating heart. Ann Thorac Surg, 2001, 71 (6):2053-2054.
  10. 10.  王東進(jìn), 賈朝相, 曹彬, 等. 右腋下縱形小切口行心臟瓣膜手術(shù)臨床觀察. 中國醫(yī)師雜志, 2004, 6 (8):1066-1067.
  11. 11.  Gil-Jaurena JM, Ji ZL, Conejo L, et al. Minimally invasive pediatric cardiac surgery. Atrial septal defect closure through axillary and submammary approaches.Rev Esp Cardiol, 2011, 64 (3):208-212.
  12. 12.  Dave HH, Comber M, Solinger T, et al. Mid-term results of right axillary incision for the repair of a wide range of congenital cardiac defects. Eur J Cardiothorac Surg, 2009, 35 (5):864-869.