胸腔镜下微创体外循环心脏手术的临床应用  

Clinical application of totally thoracoscopic minimally invasive cardiac surgery of cardiopulmonary bypass

作　　者：杨晓涵[1] 杨建安[1] 于洪涛[1] 张锐[1] 蒙茂龙[1] 

机构地区：[1]孙逸仙心血管医院心外科,广东深圳518020

出　　处：《心血管外科杂志（电子版）》2016年第2期20-23,共4页Journal of Cardiovascular Surgery(Electronic Edition)

摘　　要：目的回顾总结胸腔镜下微创体外循环心脏手术的临床经验。方法我院2012年10月至2015年12月实施胸腔镜下微创体外循环心脏手术217例,其中房间隔缺损152例,室间隔缺损33例,三尖瓣重度关闭不全2例,二尖瓣重度关闭不全9例,二尖瓣重度狭窄13例,部分性房室隔缺损4例,肺动脉瓣重度狭窄2例,三房心2例。均通过三孔法入路完成,即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1.5～2.5 cm孔状切口,完全在胸腔镜下显露术野,经股动静脉插管建立体外循环,手术原则和方法与开胸手术相同。结果 217例患者均治愈出院,无低心排出量综合征、呼吸功能不全、肾功能不全、残余分流、房室传导阻滞等严重并发症发生。术中转正中开胸手术2例（0.9%）,延长切口转胸腔镜辅助小切口手术1例。ICU停留时间平均（17±6.3）h,术后24 h引流量30～600 ml,平均（126±72）ml,201例（93%）完全避免输注血制品。术后住院时间（5±2.3）d,204例（94%）于术后1～4周恢复正常工作生活。结论经右心房、房间隔或房间沟入路完成的手术,技术上都可在胸腔镜下完成,治疗效果与正中开胸手术相同。同时具有切口美观、出血量少、输血率低、术后恢复快等优点。Objective To review the experiences of totally thoracoscopic minimally invasive cardiac surgery of cardiopulmonary bypass （CPB）. Methods 217 patients received totally thoracoscopic minimally invasive cardiac surgery procedures during the period from October 2012 to December 2015. Of the 217 patients, 152 cases were atrial septal defect, 33 cases were ventricular septal defect, 2 cases were tricuspid insufficiency, 9 were cases mitral regurgitation, 13 were cases mitral stenosis, 4 cases were partial atrioventricular septal defect, 2 cases were pulmonary valve stenosis and 2 cases were cor triatriatum. Through three hole shape incision at the right chest wall, each was 1.5 to 2.5 cm, operation fields were revealed totally by thoracoscope. CPB was built through femoral arteriovenous intubation. Results 217 patients were all cured. None of them suffered severe complications such as renal failure, respiratory failure, low cardiac output syndrome, atrioventricular block and residual shunt. 2 cases （0.9%） were changed to median thoracotomy surgery and 1 case was extend the incision to small incision surgery. The average time of ICU stay was （17±6.3） h and the average length of hospital stay was （5±2.3）d. 201 patients （93%） avoided any blood products transfusion completely, 204 patients （94%） spent one to four weeks to restore normal life. Conclusions provides small trauma, less bleeding, faster recovery. Totally thoracoscopic minimally invasive cardiac surgery The there hole incisions method of right chest wall provides clear operation field for repairing atrial septal defect, ventricular septal defect, tricuspid valve, mitral valve and partial atrioventricular septal defect. The operation is feasible and the results are as good as thoracotomy open-heart surgery.

关 键 词：胸腔镜 外科手术 微创 体外循环 

分 类 号：R654.2[医药卫生—外科学]