完全胸腔镜下体外循环心脏手术临床分析(附300例报告)

Clinical analysis of total thoracoscopic surgery by cardiopulmonary bypass(300 cases Report)

目的评定300例全胸腔镜心脏手术(三孔法)的手术质量并讨论其学习过程,汇出初学者学习曲线。方法回顾性分析本院单一术者300例全胸腔镜下心脏手术,将300例患者按手术时间的前后顺序进行编号并分为连续的三组,即A组(2015.3-2016.12),B组(2017.1-2018.10),C组(2018.11-2020.7),每组100例,每组分为5个序列,对比体外循环时间,阻断时间,手术时间,出血量,输血量,上、下腔静脉阻断后平均CVP;呼吸机辅助时间,重症监护室(ICU)时间,手术后24 h引流量。结果三组患者的体外循环时间,阻断时间,手术时间,呼吸机辅助时间均存在显着差异(P<0.05)。A组患者的指标均值大于B组患者,B组患者的指标均值大于C组患者的,随着手术例数的增多,指标均值有明显的降低,说明存在明显的学习曲线。结论全胸腔镜在常规心脏手术中有良好的临床效果。具有可复制性,可推广性,但有明显的学习曲线,在有丰富的传统开胸手术经验的前提下,可逐步开展全胸腔心脏手术。

Objective To evaluate thesurgical quality of 300 cases of total thoracoscopic cardiac surgery(three port method)and discuss its learning process,and to summarize the learning curve of beginners.Methods 300 cases with total thoracoscopic cardiac surgery performed by a single operator in our hospital were retrospectively analyzed.All cases were numbered according to the sequence of operation time and divided into three consecutive groups,namely,group A(03.2015-12.2016),group B(01.2017-10.2018),and group C(11.2018-07.2020).There were 100 cases in each group,and each group was divided into five sequences.The time of cardiopulmonary bypass,the blocking time,the operation time,the bleeding volume,the blood transfusion volume,mean CVP after inferior vena cava occlusion,ventilator assisted time,intensive care unit(ICU)time,24h drainage after surgerywere compared.Results There were significant differences among the three groups in cardiopulmonary bypass time,blocking time,operation time and ventilator assisted time(P<0.05).The average index values of group A were greater thanthose of group B,and the mean values of the indicators in group B were greater than those in group C.With the increase of the number of surgical cases,the average index valueswere significantly decreased,which indicated that there was an obvious learning curve.Conclusion Total thoracoscopy has a good clinical effect in routine cardiac surgery.It is replicable and popularized,but has an obvious learning curve.On the premise of rich experience in conventiona thoracotomy,total thoracic heart surgery can begradually carried out.