先天性心脏间隔缺损的个体化微创外科治疗策略  

Individual strategy of minimally invasive cardiac surgery in congenital cardiac septal defect

作　　者：朱家全[1] 鲍春荣[1] 丁芳宝[1] 梅举[1] ZHU Jia-quan;BAO Chun-rong;DING Fang-bao;MEI Ju(Department of Cardiothoracic Surgery,Shanghai Xinhua Hospital,Shanghai Jiaotong University,School of Medicine,Shanghai 200092,China)

机构地区：[1]上海交通大学医学院附属新华医院心胸外科,上海市200092

出　　处：《中国心血管病研究》2020年第9期809-813,共5页Chinese Journal of Cardiovascular Research

摘　　要：目的总结我院开展的侧开胸微创手术治疗心脏间隔缺损策略.方法回顾2012年1月至2019年6月在我科行微创心脏间隔缺损修补患者,排除介入及经胸封堵患者,筛选出429例.微创外科方案包括:右侧腋下竖切口组303例,其中176例房间隔缺损、122例室间隔缺损以及5例房室间隔缺损;右胸前外侧切口组121例,其中68例房间隔缺损,50例室间隔缺损和3例房室间隔缺损;左胸前外侧切口组包括5例肺动脉下型室间隔缺损.结果所有患者均成功修补,无中转胸骨正中切口.同期手术包括7例右心室流出道梗阻解除,8例二尖瓣修复和31例三尖瓣修复.3例患者行二次阻断修复心内残余病变(2例残余缺损,1例二尖瓣反流).右侧腋下切口组患者年龄及体重均显著低于右胸前外侧切口组和左胸前外侧组.平均体外循环时间(67.2±19.3)min,主动脉阻断时间(38.2±14.1)min,三组之间差异无统计学意义.全组无围术期死亡,围术期并发症包括1例短暂神经系统功能不全,3例膈肌麻痹,13例肺不张.中位ICU停留时间2天,中位术后住院时间6天.出院前超声心动图检查良好,随访中无再手术,无新发明显胸廓畸形及脊柱侧弯.结论常见心脏间隔缺损的微创外科治疗安全、有效、美观.腋下切口适合婴幼儿,右胸前外侧切口适用于青少年和成人,而左胸前外侧切口主要应用于肺动脉下室间隔缺损.Objective To summarized our strategy of minimally invasive therapy of lateral mini-thoracotomy to repair itracardiac scptal defect.Methods 429 patients who underwent minimally invasive repair of intracardiace septal defects between January 2012 and June 2019 were retrospectively reviewed,Those who underwent device elosure were excluded.The minimally invasive stratcgy included three groups.First.right sub-axillary vertical incisio group(RSAVI,n=303.176 ASDs,122 VSDs and 5 AVSDs):second,right anterior mini-tonacotomy group(RAMT,n=121.68 ASDs.50 VSDs and 3 AVSD);third,left anterior mini-thoracotomy group(LAMT,n-5.all of them were sub-pulmonary atery VSDs).Results There were no transiton fom thoracotomy to stemotonmy.Concomitant surgeries insluded 7 cases of right ventricular outflow tract obstruction relief.8 mitral repais and 31 tricuspid repairs.Three patients required second pump run for residual lesions(2 residual shunts and 1 mitral regurgiation).The age and bodly weight of RSAVI group were signficantly lower than RAMT and LAMT groups.The mean cardiopulmonary bypass time was(67.2±19.3)min and Cr0ss clamp time was(38.2±14.1)min.No significant iferenee was found among the three groups.There was n post-operative death;the complications included 1 transient neural dysfunction.3 disphragmatie paresis and 13 atelctasis The median stay in ICU was 2 days.while the median post operative hospitization was 6 days.The echocardioraply resuts before dishange indicaed no sinifiant residual lesions,.There was no reoperation,00 new onset of chest deformities and no scoliosis during the fllowr u.Conclusion The common intracardiac sepal defects can be safely and efitctively repaired by minimally invasive surgery with good cosmetic resuts.Right subaxillary vertial incision is suitable in infians.while right anterior mini-thoracotomy is more frequently used in adolescents and adults Lefi anterior mini thoracotomy is an alemative incision to repair sub-pulmonary artery VSD.

关 键 词：先天性心脏病 微创心脏外科手术 心脏间隔缺损 

分 类 号：R654.2[医药卫生—外科学]