自行研制的小儿股静脉双极管在全胸腔镜下房缺手术中的应用  

Application of self-made bipolar venous cannula in total thoracoscopic operation for atrial septal defect in children

作　　者：徐学增[1] 易定华[1] 俞世强[1] 刘金成[1] 杨剑[1] 魏旭峰[1] 王显悦[1] 陈涛[1] 

机构地区：[1]第四军医大学西京医院心血管外科中心,西安710032

出　　处：《解放军医学杂志》2007年第9期902-903,共2页Medical Journal of Chinese People's Liberation Army

基　　金：国家"十五"科技攻关计划资助课题(2004BA720A12)

摘　　要：目的探讨自行研制的小儿股静脉双极管在小儿全胸腔镜心脏手术的应用效果。方法先天性房间隔缺损患儿28例,年龄4.2±1.3岁,体重14.6±3.9kg,其中合并中、重度肺动脉高压3例,部分型肺静脉畸形引流4例,三尖瓣关闭不全3例。采用仰卧位,右肩垫高30°,气管插管,高频通气;分别在右胸胸骨旁第四肋间,腋中线第四、六肋间作胸壁小切口,以全胸腔镜经股动脉、股静脉双极插管建立体外循环,完全在胸腔镜下行房间隔修补。结果患儿手术顺利,体外循环时间53.5±17.8min,主动脉阻闭时间25.2±7.9min,开放升主动脉后心脏均自动复跳。术后无严重并发症,均痊愈出院。术后半年行经胸超声心动图检查,示右心房、心室缩小,肺动脉直径变小,心功能改善,与手术前比较差异显著(P<0.01)。结论自行研制的小儿股静脉双极管用于全胸腔镜心脏手术治疗小儿心脏病安全可靠。Objective To summarize the feasibility of the application of the self-made bipolar venous carmulae to repair atrial septal defect （ASD） totally through thoracoscope in children. Methods Twenty-eight children, aged 4. 2±1.3 years in average and weighed 14. 6 ± 3. 9kg, were diagnosed as congenital ASD. Among these patients 3 were complicated by moderate to severe pulmonary hypertension, 4 by partial pulmonary venous teratosis and 3 by tricuspid valve insufficiency. During the operation, patients were placed in a supine position, and the right shoulder was padded 30° higher than the left. A tracheal cannula was inserted and air was given with high frequency jet ventilation. Three small thoracotomies with a diameter of 2 to 3 cm were made in the 4th intercostal space on the right side of the sternum and the 4th and 7th intercostal spaces on the right middle axillary line. The cardiopulmonary bypass （CPB） was set up through the right femoral artery and femoral vein with bipolar femoral venous cannulae. The ASD was repaired through the thoracoscope. Results In all the 28 patients, the mean extracorporeal circulation time was 53. 5 ±17. 8min, and cross-clamp time was 25. 2±7. 9min. Automatic heart beat recovered after the declamping of the aorta in all the patients. No serious complication occurred. Heart murmur vanished, and ultrasonic examination was negative. Half a year after operation, ECC- showed that the size of right ventricle and right atrium became maller in size, the diameter of pulmonary artery diminished, and the cardiac function was improved （P〈0. 01）. Conclusion It is feasible and safe to use the self-made bipolar femoral venous cannulae in the total thoracoscopic surgery for the treatment of artrial septal defect in children.

关 键 词：胸腔镜 心脏外科手术 股静脉双极管 房间隔缺损 儿童 学龄前 

分 类 号：R654.2[医药卫生—外科学]