心脏镜室间隔缺损修补术的临床研究  

A clinical study on cardioscopic closure of ventricular septal defect

作　　者：王强[1] 肖明第[1] 袁忠祥[1] 卢成宝[1] 吕志前[1] 徐根兴[1] 程云阁[2] 

机构地区：[1]上海市第一人民医院心外科,200080 [2]广东省高州市人民医院心外科

出　　处：《上海医学》2005年第9期783-785,F0002,共4页Shanghai Medical Journal

摘　　要：目的总结心脏镜室间隔缺损修补术的临床应用经验并探讨心脏镜的应用前景.方法于右侧股动脉、股静脉插管建立体外循环.在右侧胸壁打3个直径为1.0～1.5 cm的小孔,于心脏镜下行室间隔缺损修补手术52例,男32例,女20例;年龄5～35岁,平均为(13.2±7.5)岁;体重15～67kg,平均为(36.4±15.6)kg.室间隔缺口均行连续缝合,其中直接缝合43例,涤纶补片修补9例.经内镜孔放置胸腔闭式引流管1根至肋膈角.结果手术顺利,无一例死亡.术后无室间隔缺损残余漏及传导阻滞.二次内镜止血3例,该3例术后出血量较大的原因均为胸壁小孔渗血.手术时间2.1～4.5 h,平均为(2.8±0.6)h;体外循环时间30～150 min,平均为(69.3±21.2)min;升主动脉阻闭时间13～60 min,平均为(26.1±9.4)min.除3例二次内镜止血者外,其余均于术后第1天由监护病房转回普通病房.术后住院时间为5～10 d.结论心脏镜室间隔缺损修补术具有创伤小、疗效佳的优点,值得在临床推广.心脏镜在心脏手术中有广阔的应用前景.Objective To summarize the experience in cardioscopic repair of ventricular septal defect and to discuss the utilization of cardioscope prospectively. Methods 52 patients underwent total endoscopic cardiac surgery, including 32 male patients and 20 female patients. 5-35 years old with 15-67 kg in body weight. The cardiopulmonary bypass was conducted via the right femoral arterial and venous double-lumen cannulas. 43 defects closed with direct running sutures, and the other 9 defects with a polytetrafluoroethylene patch; were all undertaken continuous suturing. A closed circuit drainage tube was placed to the costophrenic angle through the endoscopy. Results All patients survived after the procedure. All VSDs were successfully closed without leakage and cardiac block. Due to bleeding from the ports, 3 cases were operated once more. The procedure duration was 2.1- 4.5 h,mean （2.8±0.6） h. The durations of cross-clamp and extracorporeal circulation were 13-60 minutes, mean （26. 1±9.4） minutes and 30-150 minutes, mean （69.3±21.2） minutes respectively. All except 3 cases already mentioned, were transferred to the general ward from ICU on the following day after operation. Conclusions The cardioscopic closure of ventricular septal defect is minimally invasive and more cosmetic which worths to be applied extensively. （Shanghai Med J, 2005,28 ： 783-785）

关 键 词：内镜 室间隔缺损 室间隔缺损修补术 临床研究 心脏 体外循环时间 术后出血量 胸腔闭式引流管 涤纶补片修补 术后住院时间 

分 类 号：R654.2[医药卫生—外科学]