全胸腔镜下先天性心脏病手术1281例  

1281 cases of totally thoracoscopic cardiac surgery for congenital heart diseases

作　　者：徐学增[1] 石广永[1] 陈亚武[1] 王永祥[1] 李凯[1] 俞世强[1] 

机构地区：[1]第四军医大学西京医院心血管外科,西安710032

出　　处：《中华胸心血管外科杂志》2012年第4期195-197,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的总结全胸腔镜下先天性心脏病手术的经验。方法2000年9月至2011年11月，全腔腔镜下先天性心脏病手术1281例，其中房间隔缺损1016例，室间隔缺损110例，房室管畸形61例，法洛三联症33例，部分肺静脉异位引流24例，肺动脉瓣狭窄12例，动脉导管未闭9例，三房心8例，无顶冠状静脉窦综合征7例，完全肺静脉异位引流1例。术时右侧胸壁3孔，股动脉、静脉插管（或右房、股静脉分别插上、下腔静脉插管）建立体外循环，阻断钳阻断升主动脉，冷晶体（含血）心脏停搏液顺行灌注保护心肌。结果手术均获成功，体外循环（42±16）min，升主动脉阻断（21±9）min，术后呼吸机辅助（4．1±1．5）h，术后住院（7．1±1．4）天。术后35例发生并发症，右侧气胸16例，胸腔穿刺1次治愈；皮下气肿12例，胸带加压包扎治愈；右腋下切口液化3例、腹股沟切口液化4例，伤口延期愈合。全组术后4～8天超声心动图示畸形矫治满意。914例术后随访3个月-9年，心功能I～Ⅱ级。结论全腔镜下先天性心脏病手术安全可靠，创伤小，患儿（者）恢复快。Objective To summarize the experience of totally thoracoscopic operation for congenital heart diseases. Methods From September 2000 to November 2011, 1281 patients with congenital heart disease, including 1016 cases of atrial septal defect, 110 cases of ventricular septal defect, 61 cases of atrioventricular tube defects, 33 cases of tetralogy of Fallot, 24 cases of part anomalous pulmonary venous connection, 12 cases of pulmonary valve stenosis, 9 cases of patent ductus arteriosus, 8 case of triatriatum, 7 cases of unroofed coronary sinus syndrome, and 1 case of total anomalous pulmonary venous connection were treated totally under thoracoscope. Surgical procedures were performed through 3 troears inserted at the right chest wall, and catheters were placed in the right femoral artery and vein （ or in the right atrium, femoral vein） to set up extracorpore- al circulation. The ascending aorta was cross-clamped with long tailor-made forceps and the myocardium was protected by coronary perfusion with cold crystatloid （blood） cardioplegia. Results All the operations were completed successfully. The mean extracorporeal circulation and cross-clamping time were（ 42± 16 ）min and （21 ± 9 ）min respectively. Postoperative ventilation was withdrawn in（4.1 ±1.5） h, and the patients were discharged from the hospital in（7.1 ± 1. 4） d. 35 of the patients had postoperative complications, including 16 cases of right pneumothorax（ healed by thoracentesis）, 12 cases of subcutaneous em- physema （healed by bandaged chest）and 7 cases of fat liquefaction of the incision at the right axillary（ 3 cases）and groin（4 cases） （ delayed healing）. No severe complications occurred in this series. UCG performed 4 - 8 days after the operation revealed no residual shunt. Follow-up up to 3 months to 9 years were available in 914 cases. During the period, the heart function was confirmed as level I - II. Conclusion Totally thoracoscopic cardiac surgery is feasible, safe, and minimal invasive for patients

关 键 词：胸腔镜检查 先天性心脏病 心脏手术 

分 类 号：R654.2[医药卫生—外科学]