全胸腔镜体外循环手术在儿童先天性心脏病中的应用  

Experience of totally thoracoscopic cardiac surgery of cardiopulmonary bypass in children with congenital heart disease

作　　者：杨晓涵[1] 于洪涛[1] 张锐[1] 蒙茂龙[1] 罗令夫[1] 

机构地区：[1]深圳市孙逸仙心血管医院心脏外科,深圳518020

出　　处：《中国医师杂志》2016年第8期1205-1207,共3页Journal of Chinese Physician

摘　　要：目的 回顾总结31例先天性心脏病患儿胸腔镜下体外循环手术的临床经验.方法 采用胸腔镜下体外循环手术治疗先天性心脏病患儿31例.年龄2岁7个月至6岁,平均（4.6±1.4）岁,体重12～24（17±3.5）kg.其中房间隔缺损12例（继发孔缺损10例,原发孔缺损2例）,室间隔缺损19例.经右侧胸骨旁第三肋间、腋中线第四肋间和腋前线第六肋间三个1.5 ～2.0 cm的孔状切口,股动静脉插管建立体外循环,完全在胸腔镜下显露术野完成手术.结果 31例患儿均治愈出院,无低心排出量综合征、呼吸功能不全、肾功能不全、残余分流、房室传导阻滞等并发症.心脏阻断时间18 ～ 118（53.4 ±31.2）min;体外循环时间62～ 185（126.4 ±45.2）min;术后机械通气时间2～7（5.3±1.5）h;ICU停留时间15 ～21（19±1.3）h;术后24 h引流量0～130（57 ±36.2）ml;红细胞用量0～2（1.2±0.8）U.术后住院时间4～7（6.2± 1.2）d.结论 房间隔缺损和室间隔缺损先天性心脏病患儿,胸腔镜下修补手术可达到与传统正中开胸手术相同的治疗结果,同时具有切口小、出血少、不引起胸骨畸形愈合等优点.Objective To review the experiences of 31 cases of totally thoracoscopic cardiac surgery of cardiopulmonary bypass in children with congenital heart disease.Methods Thirty one children with congenital heart disease received totally thoracoscopic cardiac surgery procedures during the period from October 2012 to May 2016.The ages of these children were ranged from 2 years and 7 months old to 6 years old with average value （4.6 ± 1.4）years old.The body weights were ranged from 12 ～ 24 kg with average value （17 ± 3.5） kg.Among 31 children,there were 12 cases of atrial septal defect,and 19 cases of ventricular septal defect.Through three-hole shape incision at the right chest wall,each hole was 1.5 to 2.0 cm long,and operation field were revealed totally by thoracoscope.Cardiopulmonary bypass was built through femoral arteriovenous intubation.Results Thirty one children were all cured.None of them suffered severe complications such as renal failure,respiratory failure,low cardiac output syndrome,atrioventricular block,and residual shunt.Duration of cardiopulmonary bypass was 62 ～ 185 （126.4 ± 45.2） min,and duration of myocardial ischemia was 18 ～ 118 （53.4 ± 31.2）min.Duration of Postoperative mechanical ventilation was 2 ～ 7 （5.3 ±-1.5） h.Duration of intensive care unit （ICU） stay was 15 ～ 21 （19 ± 1.3） h.Drainage volume of 24 hours after operation was 0～ 130（57 ± 36.2）ml.Volume of red blood cell transfusion was 0 ～ 2 （1.2 ± 0.8） U.Postoperative hospital stay was 4 ～ 7 （6.2 ± 1.2） d.Conclusions For children with congenital heart disease as simple atrial septal defect or ventricular septal defect,thoracoscopic surgical repair can be achieved the same therapeutic results as traditional median sternotomy surgery while having advantages such as smaller incision,less bleeding and none sternal maluniorts.

关 键 词：胸腔镜检查 心脏缺损 先天性/外科学 体外循环 

分 类 号：R726.5[医药卫生—儿科]