全胸腔镜下左心房黏液瘤切除15例  

15 cases of totally thoracoscopic cardiac surgery for left atrial myxoma

作　　者：张志刚[1] 张晓慎[1] 李伦明[1] 王广阔[1] 

机构地区：[1]江门市中心医院心外科,广东省529000

出　　处：《中国心血管病研究》2014年第1期53-55,共3页Chinese Journal of Cardiovascular Research

摘　　要：目的 总结15 例全胸腔镜左房黏液瘤切除术的初步经验,探讨全胸腔镜下心内手术的安全性和适应证.方法 2012年1 月至2013 年10 月,收治15例左房黏液瘤患者,女性10 例,男性5 例,其中5例合并二尖瓣关闭不全行二尖瓣成型术.全身麻醉下,双腔气管插管,采用股动静脉插管、右侧颈内静脉引流进行体外循环.右侧胸壁3个1～2 cm切口,在全胸腔镜下行左房黏液瘤切除术.结果 15 例手术均顺利进行.1例因瘤蒂位于左房底,瘤体大暴露困难,正中切口开胸手术,其余均全腔镜下完成手术.体外循环（40±15）min,升主动脉阻断（30±12）min,术后呼吸机辅助（4.5±1.4）h,术后住院（5.6±1.3）d.无大出血、术后再次开胸止血、脑栓塞等并发症.术后病理检查,1例为左房肉瘤,其余均为左房黏液瘤.结论 全胸腔镜左房黏液瘤切除技术可行、安全,既减少了常规正中开胸的手术创伤,又没有过度延长体外循环时间造成的进一步全身器官损害,有利于患者的术后早日康复,手术切口小、美观.Objective To Summarize the experience of totaUy thoracoscopic operation for left atrial myxoma. Methods From January 2012 to October 2013, 15 patients with left atrial myxoma, including 10 females, 5 males. In which 5 patients were accepted mitral regurgitation mitral valve plasty. Catheters were placed in the right femoral artery and vein right internal jugular venous to set up extracorporeal circulation. Surgical procedures were performed through 3 notches inserted at the right chest wall, myxoma, operation were treated totally under thoraeoscope. Results MI the operations were completed successfully. The mean extracorporeal circulation and cross-clamping time were （40±15）min and （30±12）min respectively. Postoperative ventilation was withdrawn in （4.5±1.4）h, and the patients were discharged from the hospital in （5.6±1.3）d. No bleeding, postoperative re-exploration for bleeding, cerebral embolism. Pathological examination 1 case of sarcoma of the left atrium, the rest were left atrial myxoma. Conclusion Video-assisted thoraeoseopie cardiac surgery is feasible, safety, reducing the conventional median thoracotomy surgical trauma, decreasing the further damage for prolonged eardiopulmonary bypass time, is conducive to a speedy recovery of patients after surgery.

关 键 词：左房黏液瘤 胸腔镜 左房黏液瘤切除术 微创 

分 类 号：R654.2[医药卫生—外科学]