右侧小切口心脏不停跳心内直视手术体外转流经验

Techniques of Cardiopulmoanry Bypass in Beating Heart Surgery Through Right Anterolateral Thoracotomy Incision

目的:总结右前外侧小切口心脏不停跳心内直视手术体外循环特点及转流经验。方法:对1998年7月-2004年6月286例右侧切口不停跳心内直视手术进行回顾性分析。结果:本组转流时间17分-168分(36分),阻断腔静脉时间5分-114分(22分),术中心脏停搏3例,其中手术死亡1例。鱼精蛋白过敏死亡1例。282例恢复顺利,痊愈出院。结论:右进胸不停跳心内直视手术,具有良好的心肌保护效果,且功口小,创伤轻伤口愈合好、美观、胸廓稳定等优点。有一定的外科技术难度,灌注师应根据不同病种和术者技术水平,平估体外循环时间,对术中可能出现的问题及时采取处理对策,以提高手术成功率,减少手术后并发症,为手术的成功提供安全保障。

Objective： To summarize cardiopulmonary bypass management in beating heart surgery through right anterolateral thoracotomy incision. Methods： Two hurdred and eighty-six patients were operated under beating heart through mini anterlateral thoracotomy at our institution between July 1998 and June 2004, A retrospective analysis was conducted. Results： Median cardiopulmonary bypass time was 36 minutes（range 17 minutes to 168 minutes）. Median vena cava cross-clamp time was 22（range 5 minutes to 114 minutes）. There were 3 cases suffered from cardiac arrest during operation and one patient died. One patient died of protamine reaction. The others discharged from hospital without events. Conclusion： Beating heart surgery through right anterolaterl-thoracotomy incision had som advantages over conventional sternotomy including better mYOcardial protection, small skin incision, thoracic cage stable and excellent cosmetic results, Perfusionist must evaluate the strategy and difficulty depending on various diseases and operationer＇s skills. Comprehensive measures must be taken accordingly in order to reduce surgery risk and postoperative complications.