2019 年第 6 期 第 14 卷

右腋下入路经右心房切口在小儿干下型室间隔缺损修补中的应用

Minimal right subaxillary thoracotomy combined with right atrial incision for subarterial ventricular septal defect closure in children

作者：王栋吴永涛金灿刘玉华程沛范祥明刘迎龙苏俊武

英文作者：

单位：100029首都医科大学附属北京安贞医院小儿心脏中心

英文单位：

关键词：先天性心脏病；干下型室间隔缺损；右侧腋下小切口入路；右心房切口

英文关键词：

• 摘要：

• 【摘要】目的    总结右侧腋下-右心房切口修补小儿干下型室间隔缺损(VSD)的临床疗效，探讨手术技术要点。方法    收集2013年1月至2016年12月在首都医科大学附属北京安贞医院小儿心脏中心行干下型VSD修补手术100例患儿的临床资料进行回顾性分析。其中经右侧腋下-右心房切口40例（R-A组），经右侧腋下-肺动脉切口40例（R-P组），经胸部正中-肺动脉切口20例（M-P组）。经右心房切口为充分显露干下缺损，可于三尖瓣隔瓣、室上嵴及右心室流出道隔束靠近VSD边缘悬吊牵引线。比较3组患儿术前资料、体外循环时间、主动脉阻断时间、术后机械通气时间、监护室住院时间、术后住院时间，比较术后并发症及随访情况。结果    与R-P组相比较，R-A组体外循环时间、主动脉阻断时间明显缩短［(52±11)min比(58±14) min、(30±9)min比(36±10) min］，差异均有统计学意义（均P<0.05）；R-A组及R-P组术后机械通气时间均短于M-P组［(10±6)、(9±7)h比(18±9)h］，差异均有统计学意义（均P<0.05）；3组余指标比较差异均无统计学意义（均P>0.05）。3 组均无死亡及严重并发症。所有患儿均随访2～5年，随访指标满意。结论    通过右侧腋下-右心房切口修补小儿干下型VSD安全、可靠。

• 【Abstract】Objective    To summarize the clinical results of subarterial ventricular septal defect (VSD) correction through minimal right subaxillary thoracotomy combined with right atrial incision in children. Methods    From January 2013 to December 2016, clinical data of 100 children with subarterial VSD who underwent surgical repair in Beijing Anzhen Hospital, Capital Medical University were retrospectively analyzed to compare three procedures including right subaxillary thoracotomy combined with right atrial incision(group R-A, 40 cases), right subaxillary thoracotomy combined with longitudinal pulmonary artery incision(group R-P, 40 cases) and median sternotomy combined with longitudinal pulmonary artery incision(group M-P, 20 cases). The procedure through right atrial incision could fully expose subarterial VSD; tricuspid valve, supraventricular crest and right ventricular outflow septum approached to VSD were pulled to exposure the surgical field. Basic data, cardiopulmonary bypass time, aortic cross-clamping time, postoperative mechanical ventilation time, intensive care unit stay time, postoperative hospital stay time, complications and follow-up data were analyzed. Results    Cardiopulmonary bypass time and aortic cross-clamping time in group R-A were significantly shorter than those in group R-P［(52±11)min vs (58±14)min, (30±9)min vs (36±10)min］(both P<0.05). Postoperative mechanical ventilation time in group R-A and R-P were significantly shorter than that in group M-P［(10±6), (9±7)h vs (18±9)h］(both P<0.05). The other indicators were similar among three groups（all P>0.05）. All children were followed up 2 to 5 years with no late death and severe complication. Conclusion    Repair of subarterial VSD through minimal right subaxillary thoracotomy combined with right atrial incision is safe and feasible for children.