Search

右腋下小切口体外循环心内直视手术270例

目的　总结右腋下小切口在常见先天性心脏病手术中的应用经验。　方法　回顾性分析济宁医学院附属医院2009年10月至2011年6月采用右腋下小切口经第4肋间进胸，在体外循环下施行心内畸形矫治手术270例患者的临床资料，其中男132例，女138例；年龄3个月～9岁 （3.0±1.6） 岁，行室间隔缺损（VSD）修补术132例，房间隔缺损（ASD）修补术50例，ASD修补术＋部分型肺静脉异位引流（PAPVC）矫治术12例，部分型房室管畸形（PECD）矫治术15例，VSD＋ASD修补术26例，法洛四联症根治术35例。　结果　全组无手术死亡，无二次开胸止血，平均住院时间9 d，平均住ICU 1.6 d。发生右肺不张3例，右侧气胸2例，阵发性室上性心动过速1例，Ⅱ°房室传导阻滞1例。术后全部患者均获得随访，随访时间1～16个月，随访期间3例VSD术后发生小于2 mm的残余漏，其余患者恢复良好。　结论　对具有该术式适应证的患者经右腋下小切口行心内直视手术，有安全可靠、创伤小、美观等优点。

右侧腋下小切口先天性心脏病直视手术的临床应用

目的　总结右侧腋下小切口心脏直视手术临床应用的经验。　方法　回顾性分析2010年5月至2011年8月大坪医院采用右侧腋下小切口施行心脏直视手术83例先天性心脏病患者的临床资料，其中男27例，女56例；年龄7个月～59 （8.0±9.1）岁；行房间隔缺损修补术21例（心脏不停跳18例、同期行三尖瓣成形术3例、二尖瓣成形术1例），行室间隔缺损修补术60例（同期行右心室流出道疏通术4例），完全性肺静脉异位引流矫治术1例，右心室双出口矫治术1例。　结果　全组患者均顺利完成手术，体外循环时间21 ～ 185 （66.9±32.3） min，升主动脉阻断时间5 ～ 122 （32.5±25.5） min。 早期死亡1例（1.2%），死亡原因为低心排血量。门诊随访80例，失访3例。无残余漏、Ⅲ○房室传导阻滞等并发症发生。　结论　右侧腋下小切口选择性应用于先天性心脏病直视手术，安全可靠、创伤小，切口美观；但应强调适应证的合理选择、充分的术野显露、可靠的体外循环以及术中准确的手术操作。

右腋下小切口心脏直视手术3 012例的临床应用

目的 总结右腋下小切口在心脏直视手术中应用的临床经验。 方法 2001年11月至2008年7月我们采用右腋下小切口施行心脏直视手术3 012例，男1 834例，女1 178例；年龄8个月～78岁，平均年龄124岁。行室间隔缺损修补术1 999例（干下型109例），房间隔缺损修补术677例（同期行三尖瓣或二尖瓣成形术107例、行部分型肺静脉畸形引流29例），法洛三联症矫治术43例，法洛四联症矫治术35例，右室双腔心矫治术33例，房室管畸形矫治、肺动脉瓣狭窄交界切开、右心室流出道狭窄疏通、三尖瓣下移畸形行11/2心室矫治或三尖瓣置换术等共123例，二尖瓣成形术28例，二尖瓣置换术74例。 结果 全组均顺利完成手术，早期死亡5例（0.17%），死亡原因分别为灌注肺、鱼精蛋白严重过敏、术中损伤左冠状动脉、低心排血量及脑血栓昏迷。二次开胸止血8例（0.26%），切口感染6例（0.20%），肺不张、灌注肺、低心排血量、感染性心内膜炎、急性肾功能衰竭（ARF）等并发症24例（0.79%）；ARF患者均经连续床旁血液滤过治疗痊愈，其余患者经对症支持治疗痊愈。通过门诊复查、电话等形式随访1~82个月，共随访2 765例，失访247例；3例室间隔缺损出现小型残余漏，2例二尖瓣成形术后出现轻中度二尖瓣关闭不全，1例Ebstein畸形行三尖瓣成形术后出现轻中度三尖瓣关闭不全，其他患者无异常。 结论 右腋下小切口应用于心脏直视手术，有创伤小、失血少、切口美观等优点，但应严格掌握手术适应证。

右腋下垂直小切口心脏不停跳心内直视手术135例

目的 探讨右腋下垂直小切口心脏不停跳手术治疗先天性心脏病的方法。 方法 2003年11月～2006年6月，采用右腋下小切口在心脏不停跳下施行心脏手术135例；其中室间隔缺损（VSD）68例，房间隔缺损（ASD）61例(ASD合并左上腔静脉4例)，VSD+ASD 5例，冠状动静脉瘘1例。 结果 全组无手术死亡。平均住院时间8d。术后发生右肺不张2例，右侧气胸1例，切口液化2例。术后随访122例，随访时间1个月～2年，除2例VSD患者术后发生残余漏外，其余患者均恢复良好。 结论 对单纯ASD、VSD患者选择右腋下垂直小切口，在心脏不停跳下施行心内直视手术，安全可靠、手术时间短、创伤轻、恢复快、切口美观。

右腋下直切口在体外循环心脏直视手术中的应用

目的 介绍使用右腋下直切口进行体外循环心脏手术的临床结果及治疗体会，总结临床经验。 方法 使用右腋下直切口对2 058例先心病和心脏瓣膜病施行手术，其中先心病1 466例，心脏瓣膜疾病592例，所有患者均行气管内插管，静脉复合或吸入麻醉；取左侧卧位60. ~90. ，切口上端起自腋中线第3肋，下端止于腋前线第5肋，在腋中线第7肋间切 一1.5cm小口备用，沿第4肋骨上缘或第3肋进胸；沿右膈神经前切开心包并悬吊利于升主动脉及心脏显露；以长扁桃钳夹住主动脉插管前端，帮助完成主动脉插管。经手术切口内置入上腔静脉直角插管，从第7肋间小切口导入直角下腔静脉插管。阻断升主动脉，经主动脉根部插管灌注心脏停搏液，切开右心房或肺动脉和右心室流出道切口进行先天性心脏病手术。 体外循环结束后，拔除主动脉插管，缝合心包上段大部分，经第7肋间小切口放置胸腔引流管。 结果 全部患者中二次开胸止血23例（1.12%) ,切口感染或愈合不良14例（0.68%) ，发生其他各种并发症65例（316%) ，均经对症治疗后痊愈，随访时无异常。2 058例中共死亡6例，总死亡率为0.29% (6/2 058) ，其中先心病患者3例，死亡率为0.20% (3/1 466) ；心脏瓣膜病患者3例，死亡率为0.5% (3/592) .结论 右腋下直切口本身固有的美观效果、较宽的手术适应证以及与常规切口相比具有的优点，值得并适于在临床应用。

腋下小切口电视胸腔镜手术治疗自发性气胸82例

腋下垂直小切口行肺切除术

目的　探讨腋下垂直小切口行肺切除术的方法特点。　方法　采用腋下垂直小切口行肺切除术 15 1例 ,切口长 8～ 12 cm。肺楔形切除术 2 3例 ,肺叶切除术 95例 ,支气管袖式肺叶切除术 2例 ,全肺切除术 31例。　结果　全组无手术死亡。开胸过程中出血量均少于 2 0 ml;术后胸腔引流量 16 0～ 72 0 ml,平均 30 0 ml;共清扫胸内淋巴结 12 4 5个 ,其中转移阳性淋巴结 2 4 3个 ,占 19.5 %。术后伤口疼痛均较轻 ,止痛时间 2～ 3天。术后住院天数平均 12天。结论　腋下垂直小切口行肺切除术是可行的 ,能完成对胸内淋巴结的清扫 ,减小肺部肿瘤手术切口的创伤。

自发性气胸两种手术方式的对比观察

【摘要】　目的　比较腋下小切口与常规后外侧切口手术治疗自发性气胸的临床疗效。　方法　将2006年5月-2010年1月收治的64例自发性气胸患者，按手术时间和患者自身对手术的选择性随机分为腋下小切口手术组（A组，34例）和常规后外侧切口手术组（B组，30例）。两组患者性别、年龄、单双侧、病程等一般资料比较差异无统计学意义（Pgt;0.05），具有可比性。两组均采用肺大疱切除修补术及壁层胸膜机械性摩擦。　结果　两组术后切口均Ⅰ期愈合，无切口感染等并发症发生。两组随访时间均为3~24个月，平均12.6个月；术后6个月时均无复发。A组手术时间、术中出血量、术后引流量、术后住院时间、住院费用方面均明显优于B组，差异有统计学意义（Plt;0.05）。　结论　两种手术方法均安全，但与常规后外侧切口比较，腋下小切口具有手术时间短、创伤小、恢复快、住院费用低等优点。

Clinical value between axillary thoracotomy and video-assisted thoracoscopic lobectomy in the treatment of patients with lung cancer

Objective To compare the subaxillary small incision thoracotomy (SSIT) with video-assisted thoracic surgery (VATS) for patients with lung cancer. Methods Retrospective analysis of 142 patients with lung cancer in Department of Thoracic Surgery, The First People's Hospital of Neijiang from January 2014 to April 2016 was conducted. There were 86 males and 56 females, aged 40-77 years. Patients were divided into a VATS group (n=72) and a SSIT group (n=70). The following postoperative data were evaluated: operation time, number of dissected lymph nodes, intraoperative bleeding, postoperative chest drainage volume, drainage duration, postoperative ambulation time, average hospital stay, postoperative complications, hospitalization cost, early postoperative incision pain (visual analogue scale, VAS) and other indicators. Results There were no statistically significant differences between the two groups in the operation time (120.8±20.4 minvs. 126.2±21.6 min,P=0.124), the dissected lymph node (11.1±2.0vs. 11.4±1.9,P=0.333) and the postoperative complications rate (13.9% vs. 15.7%, P=0.759). Laparoscopic intraoperative bleeding and postoperative drainage volume were significantly less in the VATS group than those in the SSIT group (123.2±26.9 mlvs. 156.4±24.0 ml,P<0.001; 227.0±75.5 mlvs. 334.3±89.1 ml,P<0.001). Postoperative drainage duration, postoperative ambulation time and hospital stay were shorter in the VATS group than those in the SSIT group (2.5±0.5 dvs. 3.1±0.6 d, 1.5±0.5 dvs. 2.2±0.6 d, 6.5±0.5 dvs. 7.4±0.6 d, allP<0.001). The average hospitalization cost of the VATS group was significantly higher than that of the SSIT group (42 338.9±8 855.7 yuanvs. 32 043.7±7 178.1 yuan,P<0.001). There was no significant difference in the operation cost and anesthesia cost between the two groups (P>0.05). The early postoperative pain of laparoscopic group was less, but the difference was not statistically significant (P>0.05). Conclusion The hospitalization cost of the SSIT is lower than that of thoracic surgery, which may be beneficial to the appilication in primary hospitals.

Clinical efficacy of right vertical subaxillary incision in the treatment of doubly committed subarterial ventricular septal defect: A retrospective cohort study

ObjectiveTo analyze the clinical efficacy of right midaxillary straight incision surgery in the treatment of doubly committed subarterial ventricular septal defect. MethodsThe clinical data of children with doubly committed subarterial ventricular septal defect who received surgeries in our hospital from August 2020 to July 2023 were analyzed retrospectively. All the children underwent surgical repair and were divided into two groups according to the incision position, including a right midaxillary straight incision group and a median incision group. The outcomes were compared between the two groups. ResultsA total of 187 patients were enrolled. There were 102 patients in the right midaxillary straight incision group, including 55 males and 47 females with a median age of 26.0 (5.0, 127.0) months and a median weight of 12.5 (5.1, 32.8) kg at surgery. There were 85 patients in the median incision group, including 37 males and 48 females with a median age of 4.0 (2.0, 168.0) months and a median weight of 6.7 (4.8, 53.9) kg at surgery. No mortality occurred in the study. There was no statistical difference between the two groups in the cardiopulmonary bypass time (50.0±18.4 min vs. 46.1±15.7 min) or aortic cross-clamping time (31.3±18.6 min vs. 26.3±17.5 min) (P>0.05). Compared to the median incision group, the time from the end of cardiopulmonary bypass to the closure of chest (22.3±15.6 min vs. 37.1±13.4 min, P=0.001), postoperative hospital stay (6.9±3.9 d vs. 8.6±3.6 d, P=0.002), the length of incision (4.3±2.7 cm vs. 8.5±3.2 cm, P=0.001), drainage volume (79.0±32.2 mL vs. 100.2±43.1 mL, P=0.001), and the pain score on the 2nd and the 3rd day after the operation were statistically better in the right midaxillary straight incision group (P<0.05). The medical experience and incision satisfaction scores at discharge were higher than those in the median incision group (P<0.05). During the follow-up of 21.0 (1.0, 35.0) months, no residual shunt was detected and all patients in both groups had a normal cardiac function and mild or less valve regurgitation. ConclusionCompared to the median incision, minimally invasive right midaxillary straight incision is equally safe and reliable in the treatment of doubly committed subarterial ventricular septal defect with the advantages of cosmetic and fast recovery.