右后外侧小切口剖胸治疗冠状动脉右心室和/或右心房瘘
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摘要
目的:总结经右外侧腋下小切口入胸体外循环辅助直视下治疗冠状动脉右心室右心房瘘的手术经验及效果。方法:选取本院2002年1月至2018年12月,行冠状动脉右心室和/或右心房瘘矫治术患儿31例,其中经胸骨正中开胸完成手术矫治的患儿16例(正中组),男性9例,女性7例,中位年龄11.8个月(6～32)个月,中位体质量12.7 kg(7.5～29 kg)。其中右冠状动脉右心室瘘9例,左冠状动脉右心室瘘5例,右冠状动脉右心房瘘2例;经右外侧小切口剖胸(右侧组)行手术矫治的患儿15例,男性9例,女性6例。中位年龄10.8个月(5～28个月),中位体质量11.6 kg(5.6～18)kg。右冠状动脉右心室瘘9例,左冠状动脉右心室瘘4例,右冠状动脉右心房瘘2例。均在全身麻醉体外循环辅助下完成冠状动脉右心室和/或右心房瘘矫治术。结果:右侧组术后无死亡。术后残余瘘2例。正中死亡1例,死于低心排出量综合征(低心排);术后残余瘘2例。右侧组手术时间、切口长度、ICU停留时间、术后引流量、术后输血量、术后呼吸机辅助时间以及住院时间都显著低于正中组;主动脉阻断时间差异无统计学意义。随访3～38个月,心脏功能恢复良好。结论:经右侧腋下小切口直视下行冠状动脉右心室右心房瘘矫治手术,手术安全可靠,术野清晰,创伤小,术后恢复良好。
Objective: To summarize the experiences and the treatment effect of right mini-lateral-thoracotomy in operation for coronary right ventricular/right atrial fistula. Methods: From January 2002 to December 2018, Thirty-one children underwent right ventricular and/or right atrial fistula correction. 16 children with right ventricle and/or right atrial fistula in the same period of transmedian thoracotomy in our hospital were selected as the Median incision group, There were 9 males and 7 females, with an average age of 11.8 months(6-32 months) and an average body mass of 12.7 kg(7.5-29 kg). 9 cases of right coronary artery right ventricular fistula, 5 cases of left coronary artery right ventricular fistula and 2 cases of right coronary artery right atrial females; 15 children with Coronary right ventricular/right atrial fistula underwent open-heart operation by the right anterolateral thoracotomy as the Right incision group, There were 9 males and 6 females, The average age of them was 10.8 months(5-28 months), and the average weight was 11.6 kg(5.6-18 kg). There were 8 cases of right coronary artery right ventricular fistula, 3 cases of left coronary artery right ventricular fistula and 2 cases of right coronary artery right atrial fistula.Resuits:There was no mortality in the research group. Postoperative residual fistula was observed in 2 cases. One case died in the control group from low cardiac output syndrome and postoperative residual fistula 2 cases. The operation time,length of incision, postoperative drainage,volume of blood transfusion, postoperative mechanical ventilationin time,postoperative ICU residence time and hospital stays of patient under right anterolateral thoracotomy were significantly lower than those in the control group. There was no statistically significant difference in aortic occlusion time Follow up for 3～38 months, cardiac function recovered well. Conclusions: The right mini-lateral-thoracotomy in operation for Coronary right ventricular/right atrial fistula is a safe and effective alternative to a median sternotomy for correctiong of some congential heart diseases.Advantages of this approach include less injury,maintaining the integrity of the bony cage.The scar is small and the cosmetic effect is evident.
Objective: To summarize the experiences and the treatment effect of right mini-lateral-thoracotomy in operation for coronary right ventricular/right atrial fistula. Methods: From January 2002 to December 2018, Thirty-one children underwent right ventricular and/or right atrial fistula correction. 16 children with right ventricle and/or right atrial fistula in the same period of transmedian thoracotomy in our hospital were selected as the Median incision group, There were 9 males and 7 females, with an average age of 11.8 months(6-32 months) and an average body mass of 12.7 kg(7.5-29 kg). 9 cases of right coronary artery right ventricular fistula, 5 cases of left coronary artery right ventricular fistula and 2 cases of right coronary artery right atrial females; 15 children with Coronary right ventricular/right atrial fistula underwent open-heart operation by the right anterolateral thoracotomy as the Right incision group, There were 9 males and 6 females, The average age of them was 10.8 months(5-28 months), and the average weight was 11.6 kg(5.6-18 kg). There were 8 cases of right coronary artery right ventricular fistula, 3 cases of left coronary artery right ventricular fistula and 2 cases of right coronary artery right atrial fistula.Resuits:There was no mortality in the research group. Postoperative residual fistula was observed in 2 cases. One case died in the control group from low cardiac output syndrome and postoperative residual fistula 2 cases. The operation time,length of incision, postoperative drainage,volume of blood transfusion, postoperative mechanical ventilationin time,postoperative ICU residence time and hospital stays of patient under right anterolateral thoracotomy were significantly lower than those in the control group. There was no statistically significant difference in aortic occlusion time Follow up for 3～38 months, cardiac function recovered well. Conclusions: The right mini-lateral-thoracotomy in operation for Coronary right ventricular/right atrial fistula is a safe and effective alternative to a median sternotomy for correctiong of some congential heart diseases.Advantages of this approach include less injury,maintaining the integrity of the bony cage.The scar is small and the cosmetic effect is evident.
引文
[1] Kamiya H,Yasuda T,Nagamine H,et al.Surgical treatment of congenital coronary artery fistulas:27 years experience and a review of the literature.J Card Surg,2002,17:173-177.
[2] Kirklin JW,Barrtt-Boyes BG.Right anterolateral thoracotomy for cardiopulmonary bapass.//Kirklin JW,Barratt-Boyes BG.Cardiac Surgery.New York:Churchill Livingstone,1988:29-82.
[3] Guedes MA,Pomerantzeff PM,Brandao CM,et al.Mitral valve surgery using right anterolaterai thoracotomy:is the aortic cannulation a safety procedure?Rev Bras Cir Cardiovasc,2010,25:322-325.
[4] 苏俊武,凌雁,李晓峰,等.右外侧小切口剖胸矫治小儿先天性心脏病1972例.心肺血管病杂志,2012,31:358-360.
[5] David M,Probal G,Sergey P,Minimally invasive congenital cardiac surgery through right anterior minithoracotomy approach.Ann Thorac Surg,2008,85:831-835.
[6] 李建荣,刘迎龙,于存涛,等.右外侧小切口室间隔缺损修补术疗效及生活质量研究.中国微创外科杂志,2009,9:399-403.
[7] 范祥明,陈哲,李磊,等.右外侧小切口剖胸矫治合并心底畸形的室间隔缺损体会.心肺血管病杂志,2012,31:364-366.
[2] Kirklin JW,Barrtt-Boyes BG.Right anterolateral thoracotomy for cardiopulmonary bapass.//Kirklin JW,Barratt-Boyes BG.Cardiac Surgery.New York:Churchill Livingstone,1988:29-82.
[3] Guedes MA,Pomerantzeff PM,Brandao CM,et al.Mitral valve surgery using right anterolaterai thoracotomy:is the aortic cannulation a safety procedure?Rev Bras Cir Cardiovasc,2010,25:322-325.
[4] 苏俊武,凌雁,李晓峰,等.右外侧小切口剖胸矫治小儿先天性心脏病1972例.心肺血管病杂志,2012,31:358-360.
[5] David M,Probal G,Sergey P,Minimally invasive congenital cardiac surgery through right anterior minithoracotomy approach.Ann Thorac Surg,2008,85:831-835.
[6] 李建荣,刘迎龙,于存涛,等.右外侧小切口室间隔缺损修补术疗效及生活质量研究.中国微创外科杂志,2009,9:399-403.
[7] 范祥明,陈哲,李磊,等.右外侧小切口剖胸矫治合并心底畸形的室间隔缺损体会.心肺血管病杂志,2012,31:364-366.