Prêtre René, Kadner Alexander, Dave Hitendu, Dodge-Khatami Ali, Bettex Dominique, Berger Felix
Pediatric Cardiac Surgery, Department of Surgery, University Hospital Zurich, Switzerland.
J Thorac Cardiovasc Surg. 2005 Aug;130(2):277-81. doi: 10.1016/j.jtcvs.2005.03.023.
We sought to evaluate the safety of a right axillary incision, a cosmetically superior approach than anterolateral thoracotomy, to repair various congenital heart defects.
All the patients who were approached with this incision between March 2001 and October 2004 were included in the study. There were 80 patients (median age, 4 years) with atrial septal defect closure (38 patients), repair of partial abnormal pulmonary venous return (14 patients), partial atrioventricular canal (16 patients), and perimembranous ventricular septal defect (12 patients). The surgical technique involved peripheral and central cannulation for institution of cardiopulmonary bypass. Electrically induced ventricular fibrillation was used for defects located in front of the atrioventricular valves, and cardioplegic arrest was used for those located at the level or behind these valves.
The repair was possible without need for conversion to another approach. One patient sustained a transient neurologic deficit. The patients were all in excellent condition after a mean follow-up of 14 months. The cardiac defect was repaired with no residual defect in 75 patients and with trivial residual defect in 5 patients (3 with mitral valve regurgitation, 1 with atrial septal defect, and 1 with ventricular septal defect). The incision healed properly in all, and the thorax showed no deformity.
The right axillary incision provides a quality of repair for various congenital defects similar to that obtained by using standard surgical approaches. Because it lies more laterally and is hidden by the resting arm, it provides superior cosmetic results compared with conventional incisions, including the anterolateral thoracotomy. Finally, the incision is unlikely to interfere with subsequent development of the breast.
我们试图评估右腋下切口（一种在美容方面优于前外侧开胸术的入路方式）修复各种先天性心脏缺陷的安全性。
纳入2001年3月至2004年10月间采用该切口入路的所有患者。共有80例患者（中位年龄4岁），其中房间隔缺损修补术38例、部分性肺静脉异位引流修复术14例、部分房室管畸形16例、膜周部室间隔缺损12例。手术技术包括用于建立体外循环的外周和中心插管。位于房室瓣前方的缺损采用电诱导心室颤动，位于这些瓣膜水平或后方的缺损采用心脏停搏。
修复手术无需转为其他入路方式即可完成。1例患者出现短暂性神经功能缺损。平均随访14个月后，所有患者情况良好。75例患者心脏缺损修复后无残余缺损，5例患者有轻微残余缺损（3例二尖瓣反流、1例房间隔缺损、1例室间隔缺损）。所有患者切口愈合良好，胸部无畸形。
右腋下切口对各种先天性缺损的修复质量与采用标准手术入路相似。由于其位置更偏外侧且被静止的手臂遮挡，与包括前外侧开胸术在内的传统切口相比，它具有更好的美容效果。最后，该切口不太可能影响乳房的后续发育。
