完全胸腔镜下心脏外科手术43例报道  

Cardiac surgery under complete thoracoscopy: report of 43 eases

作　　者：于涛[1] 张晓慎[2] 刘胜中[1] 谭今[1] 向波[1] 蒋露[1] 黄克力[1] 

机构地区：[1]四川省医学科学院·四川省人民医院心脏外科中心,四川成都610072 [2]广东省心血管病研究所,广东省医学科学院,广东省人民医院心外科,广东广州510080

出　　处：《实用医院临床杂志》2016年第1期11-12,共2页Practical Journal of Clinical Medicine

摘　　要：目的总结完全胸腔镜下心脏外科手术的临床经验。方法回顾性分析四川省人民医院心脏外科中心2014年1月至2015年10月完成的全胸腔镜下心脏手术43例。房间隔缺损19例,其中合并三尖瓣中-重度关闭不全13例;二尖瓣瓣膜病22例,其中合并三尖瓣中-重度关闭不全17例,合并房颤者11例;单纯三尖瓣关闭不全者2例。结果所有患者均顺利完成手术,无手术死亡。全组无术后残余漏、瓣周漏,无术中扩大切口,无二次开胸止血。体外循环时间31~147 min[(56±33)min];升主动脉阻断时间17~95 min[(44±32)min];手术时间127~311 min[(169±51)min]。术后呼吸机辅助时间(4.8±1.5)h。胸液引流量75~350 ml[平均(101±46)ml]。术后住院时间(6.5±2.7)d。81.4%(35/43)的患者住院期间未接受任何血制品的输注。术后随访1~22个月,心功能均为I^II级。结论完全胸腔镜下行心脏手术创伤小、恢复快、安全可行。Objective To summarize the clinical experiences of cardiac surgery with complete thoracoscopy. Methods We retrospectively analyzed 43 cases who underwent the completely thoracoscopic cardiac surgery in our department from January 2014 to October 2015. These patients included 19 cases with atrial septal defect in which 13 were combined with moderate to severe tricuspid regurgitation,22 cases with mitral valve disease in which 17 were combined with moderate to severe tricuspid regurgitation and 11 with atrial fibrillation and 2 cases with isolated tricuspid regurgitation. Results All the operations were performed successfully. There was no perioperative mortality, postoperative residual leakage, perivalvular leakage and incision expansion, and reexploration for postoperative bleeding. The mean extraeorporeal circulation and cross-clamping time were 56 ± 33 min （ranged from 31 min to 147 min） and 44 ± 32 min （ranged from 17 min to 95 min） ,respectively. Postoperative ventilation support time was 4. 8 ± 1.5 h. The mean volume of chest drainage was 101 ± 46 ml （ranged from 75 ml to 350 ml）. Patients were discharged from the hospital in 6. 5 ± 2. 7 d postoperatively. There were 81.4% of patients （35/43） received no blood transfusion. Follow-up time ranged from 1 month to 22 months, and all patients were in 4class Ⅰ/Ⅱ defined by scores of New York Heart Association （NYHA）. Conclusion The completely thoracoscopic cardiac surgery is safe, feasible and minimal invasive. It has quick recovery and good outcomes.

关 键 词：电视胸腔镜 微创外科 心脏手术 

分 类 号：R654.2[医药卫生—外科学]