全胸腔镜微创心脏手术单中心临床经验  

Totally thoracoscopic cardiac surgery in Xijing Hospital--clinical experience

作　　者：俞世强[1] 徐学增[1] 易蔚[1] 金振晓[1] 赵荣[1] 金艳[1] 易定华[1] 

机构地区：[1]中国人民解放军第四军医大学心血管外科,西安710032

出　　处：《中国体外循环杂志》2016年第2期87-90,共4页Chinese Journal of Extracorporeal Circulation

基　　金：国家十二五科技支撑计划课题(2011BAI11B20);国家自然科学基金(81470415;81470411;81270170;81570330;81570231;81570230;81570232);陕西省国际科技合作与交流计划项目(2015KW-047);陕西省社会发展公关计划(2015SF104);陕西省科技统筹创新工程计划项目(2013KTCL03-01);陕西省自然科学基金(2014JM4106);西京医院学科助推计划(XJZT14203)

摘　　要：目的总结全胸腔镜微创心脏手术单中心临床经验。方法 2000年3月至2016年3月对3 864例心脏病开展了全胸腔镜微创心脏手术,男1 312例,女2 552例,年龄0.5~75（32.4±35.2）岁。其中先天性心脏病2 601例,瓣膜病1 011例,心房黏液瘤224例,心脏肿瘤18例,孤立性房颤9例,二尖瓣瓣周漏1例。采用胸壁3孔入路,建立外周体外循环,阻断升主动脉,冷心脏停搏液顺灌保护心肌,完成心脏手术。结果全胸腔镜微创心脏手术死亡率为0.46%,其中先天性心脏病手术死亡率为0.31%,二尖瓣置换或成形手术死亡率为0.79%;手术后并发症发生率2.3%。连续698例全胸腔镜微创手术的先天性心脏病患者比同期710例常规开胸心脏手术患者体外循环转流时间、升主动脉阻闭时间、术后呼吸机使用时间、平均ICU停留时间、平均住院费用、手术病死率没有显著差异,而手术时间和住院天数明显缩短,手术后引流量和主要并发症明显减少,术后无胸骨畸形发生。存活的患者术后随访1~192（102.3±68.1）个月,无残余分流和明显瓣膜返流,心功能明显好转。结论全胸腔镜微创心脏手术安全可靠,创伤小,并发症少,恢复快,具有较好的中长期效果。Objective To summarize the experience of totally thoracoscopic cardiac surgery（TTCS）in Xijing hospital.Methods From March 2000 to March 2011, 3864 patients underwent TTCS in Xijing hospital, including 2601 cases of congenital heart dis-ease, 1011 cases of valve disease, 224 cases of cardiac myxoma, 18 cases of cardiac tumor, 9 cases of atrial fibrillation, and 1 case ofmitral perivalvular leak. Surgical procedures were performed through 3 holes inserted at the right chest wall, and cannulas were placedin the right femoral artery and vein to set up extracorporeal circulation. The ascending aorta was cross-clamped with long tailor-madeforceps and the myocardium was protected with intracoronary perfusion by usingcold blood cardioplegia.Results All the operationswere completed successfully. The total operative death was 0.46%, and that of congenital heart disease was 0.31%, of mitral valve re-pair/ replacement 0.79%. The major complication incidence was 2.3%. There was no significant difference in cardiopulmonary bypasstime, aorta clamp time, ICU stay, hospital cost, and operative mornality between 698 consecutive patients who underwent TTCS and710 who had conventional thoracotomy. However, TTCS benefited patients with shorter operative time, shorter length of hospital stay,less postoperative drainage volume, lower incidence of major complication and wound healing. The average follow-up time was 1-192（102.3±68.1） months and the heart function was uncer NYHA class Ⅰ-Ⅱ.Conclusion TTCS is a feasible, safe, and minimal inva-sive approach for patients and enables a quick recovery and good median to long term outcomes.

关 键 词：全胸腔镜 心脏病 微创心脏手术 临床经验 

分 类 号：R654.2[医药卫生—外科学]