全胸腔镜下心房黏液瘤摘除术44例  

44 Cases of totally thoracoscopic cardiac surgery for atrial myxoma

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205-206,共2页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的总结全胸腔镜下心房黏液瘤手术的经验。方法2007年12月至2011年11月，全胸腔镜下心房黏液瘤手术44例，其中左心房黏液瘤35例，右心房黏液瘤6例，双心房黏液瘤3例。通过右侧胸壁3孔建立体外循环，股动脉、静脉插管（或右心房、股静脉分别插上、下腔静脉插管），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（49±18）min，升主动脉阻断（28±10）min，术后呼吸机辅助（3．8±1．4）h，术后住院（6．8±1．3）天。术后并发症3例，1例为腹股沟切口液化，伤口延期愈合；2例皮下气肿，胸带加压包扎治愈。无严重并发症发生。全组术后3—5天超声心动图示手术效果满意。术后失访20例，余24例随访2个月至4年，心功能均I级。结论全胸腔镜下心房黏液瘤手术安全可靠，创伤小，患者恢复快。Objective To Summarize the experience of totally thoracoscopic operation for atrial myxoma. Methods From December 2007 to November 2011,44 patients with atrial myxoma, including 37 cases of Left atrial myxoma, 6 cases of Right atrial myxoma, 1 case of double atrial myxoma 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 extraeorporeal circulation. The ascending aorta was cross-clamped with long tailor-made forceps and the myocardium was protected by coronary perfnsion with cold erystalloid （blood） cardioplegia. Results All the operations were completed successfully. The mean extracorporeal circulation and cross-clamping time were（49 ± 18 ）min and （28 ± 10） rain respectively. Postoperative ventilation was withdrawn in（3.8 ± 1.4） h, and the patients were discharged from the hospital in （6.8 ±1. 3 ） d. 3 of the patients had postoperative complications, including 1 case of fat liquefaction of the inci- sion at the right groin （delayed healing）, 2 cases of subcutaneous emphysema （healed by bandaged chest）. No severe complications occurred in this series. UCG performed 3 - 5 days after the operation revealed surgical results were satisfactory. Follow-up up to 2 months to 4 years were available in all cases. During the period, the heart function was confirmed as level I Conclusion Video-assisted thoraeoseopie cardiac surgery is feasible, safe, and minimal invasive for patients, resulting in quick recovery and good cosmetic outcomes.

关 键 词：胸腔镜检查 心脏肿瘤 黏液瘤 心脏外科手术 

分 类 号：R732.1[医药卫生—肿瘤]