胸腔镜辅助下心脏手术体外循环的建立与管理

Application of Extacorporeal Circulation with Video-assisted Thoracoscopy in Heart Operation

目的总结胸腔镜下心脏手术的体外循环建立方法和管理。方法分析120例心脏病患者借助于电视胸腔镜进行房间隔缺损修补,室间隔缺损修补,二尖瓣置换,Ebste in畸形、部分房室管畸形矫治的体外循环过程和术后结果。结果1例患者停体外循环后因血氧饱和度偏低,延长第4肋间切口探查;1例因手术操作导致出血而延长切口再次插管建立体外循环;1例患者因残余漏再次手术;其余117例患者手术过程顺利。120例患者术后均恢复良好。结论胸壁打孔体外循环下完全借助于电视胸腔镜实施心脏手术安全、可行;开展此手术的初期体外循环时间和主动脉阻闭时间相对较长,应加强体外循环的管理。

OBJECTIVE To summarize the way and management of extacorporeal circulation （ECC） with video -assisted thoracoscopy in heart operation. METHODS The process and postoperative results of 120 patients undergoing operation of ECC with video - assisted thoracoscopy were analyzed. The patients involved were 50 cases of atrial septal defeet ,66 cases of ventricular septal defect, 1 case of mitral valve stenosis, 1 case of aneurysm of the Valsalva＇s sinus , 1 case of Ebstein deformed and 1 case of partial atrioventricular canal defect. RESULTS Of the 120 cases,two patients were reoperated because of there remained shunt of ventricular septal defect. The incison of another two patients were extende during operation because of lower oxygen saturation and aorta wall bleeding. The rest of cases were successfully operated by applying ECC with video -assisted thoracoscopy. All patients recovered well postoperatively and discharged unevent- fully. CONCLUSION Heart operations can be done by applying ECC with totally video -assisted thoracoscopy. The method is safe and practicable . But it should be modified to shorten the duration of ECC and aorta clamping.