全胸腔镜下室间隔缺损修补手术单中心临床分析  

Totally thoracoscopic closure of ventricular septal defect: A single-center clinical analysis

作　　者：兰怀 程云阁 贾宝成 柴余良 LAN Huai;CHENG Yunge;JIA Baocheng;CHAI Yuliang(Department of Cardiovascular Surgery,General Hospital of Northern Theater Command,Shenyang,110016,P.R.China;Department of Thoracoscopic Cardiacsurgery,Shanghai Yodak Cardiothoracic Hospital,Shanghai,200235,P.R.China)

机构地区：[1]北部战区总医院心血管外科,沈阳110016 [2]上海远大心胸医院腔镜科,上海200235

出　　处：《中国胸心血管外科临床杂志》2020年第2期164-167,共4页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：上海市卫生局科研专项基金（20124326;20124335）

摘　　要：目的总结全胸腔镜下室间隔缺损修补手术临床经验。方法回顾性分析2008年5月至2018年12月我院449例行全胸腔镜下心脏手术的室间隔缺损患者的临床资料,男232例、女217例,年龄3~55(17.3±11.2)岁。结果449例患者手术时间为1.8~4.0(2.4±0.3)h,体外循环时间42~136(64.2±11.6)min,升主动脉阻断时间17~84(28.4±10.7)min,术后呼吸机辅助时间3~45(6.9±3.8)h,术后住重症监护室时间16~68(20.5±5.6)h,术后胸腔闭式引流量50~1060(213.1±117.2)mL,术后住院时间5~16(6.9±1.3)d。全组患者均治愈出院,无中转正中开胸患者。出现并发症11例(2.4%),包括术中再次手术1例,术后胸腔镜下二次止血3例,切口感染3例,室间隔缺损残余漏2例,股动脉切口狭窄合并血栓栓塞1例,右侧气胸1例。患者术后随访1~128(72.2±33.9)个月,无再次手术患者,室间隔缺损残余漏2例,二尖瓣及主动脉瓣轻中度关闭不全各1例,心功能明显好转。结论全胸腔镜下室间隔缺损修补手术具有并发症少、术后恢复快及安全可靠等优势,近中期疗效良好。Objective To summarize the experience of totally thoracoscopic cardiac surgery for ventricular septal defect.Methods Clinical data of 449 patients undergoing totally thoracoscopic cardiac surgery for ventricular septal defect from May 2008 to December 2018 in Shanghai Yodak Cardiothoracic Hospital were analyzed retrospectively.There were 232 male and 217 female patients,aged from 3 to 55 years with a mean age of 17.3±11.2 years.Results All the operations were completed successfully.Mean operative time was 2.4±0.3 h.The mean extracorporeal circulation time and aortic cross-clamp time was 64.2±11.6 min and 28.4±10.7 min,respectively.Mechanical ventilation time and intensive care unit stay was 6.9±3.8 h and 20.5±5.6 h,respectively.Postoperation drainage quantity was 213.1±117.2 mL.The hospital stay was 6.9±1.3 d.Intraoperative and postoperative complications occurred in 11 patients(2.4%),including 1 patient of intraoperative reoperation,3 patients of reoperation for bleeding,3 patients of the incision infection,2 patients of small residual shunt,1 patient of right femoral artery incision stenosis complicated by thromboembolism and 1 patient of right pleural cavity pneumothorax.The mean follow-up time was 72.2±33.9 months.During the period,there was no reoperation,but 2 patients of ventricular septal defect small residual shunt,1 patient of mild-moderate mitral valve and 1 patient of mild-moderate aortic valve incompetence,respectively.During the period,heart function of the patients was NYHAⅠ-Ⅱ.Conclusion Totally thoracoscopic cardiac surgery for ventricular septal defect is a safe and effective treatment,with few serious complications,fast recovery for patients and good short to medium-term outcomes.

关 键 词：胸腔镜 微创心脏手术 先天性心脏病 室间隔缺损 

分 类 号：R654.2[医药卫生—外科学]