完全胸腔镜下体外循环心脏手术674例临床分析

Thoracoscopic cardiac surgical procedures:a report of 674 cases

目的探讨经胸腔镜体外循环心脏手术的疗效与安全性。方法于2000年5月至2006年5月行经胸腔镜体外循环心脏手术674例。包括房间隔缺损修补术238例,室间隔缺损修补术380例,二尖瓣置换术56例。使用30°胸腔镜及配套手术器械;股动脉插供血管,股静脉和(或)上腔静脉插引流管行体外循环;胸腔内操作均在胸腔镜下进行,以胸腔镜显示屏为手术野。结果本组674例患者手术成功645例,成功率96%,术中扩大切口28例。手术时间1.8～5.6 h,平均(2.8±1.2)h;体外循环时间56～198 min,平均(78±2.3)min;升主动脉阻闭时间为8～96 min,平均(31±19)min。术后胸腔闭式引流量20～1200 ml,平均(140±46)ml。死亡1例,死亡率0.15%,死亡原因为术后脑出血。并发症46例,发生率7%。包括二次止血8例;残余漏5例,其中二次手术2例;右侧血气胸33例。结论完全胸腔镜下房间隔缺损修补术、室间隔缺损修补术和二尖瓣置换术是安全可行的。

Objective To evaluate the efficacy and safety of thoracoscopic cardiac surgical procedures under extracorporeal circulation. Methods From May 2000 to May 2006, 674 patients received thoracoscopic cardiac surgery under extracorporeal circulation. These procedures included atrial septal defect occlusion for 238 patients, ventricular septal defect occlusion for 380 patients and mitral valve replacement for 56 patients. Thirty degree thoracoscopes and femoral extracorporeal circulation were used. The aorta was cross-clamped and the myocardium was protected by coronary perfusion with cold crystal or blood cardioplegie. Results The operation successed in 645 patients （96% ,645/674）. Enlarging the incision was performed in 28 patients. Operation time was from 1.8 h to 5. 6 h with the mean of （ 2. 8 ± 1.2） h. Cardiopulmonary bypass time was from 56 min to 198 min with the mean of （ 78 ± 2. 3 ） min. Aortic crossclamp time was from 8 min to96 min with the mean of （31 ± 19） min. The volume of chest drainage was （ 140 ± 46 ） ml. None but one postoperative death occurred, the mortality was 0. 15%. Postoperative complications occurred in 48 cases （7%）, including bleeding in 8 patients, leakage in 5 patients （reoperation in 2 patients ） and hemo-pneumothorax in 33 patients. One patient died postoperatively from encephalorrhea （0. 15% , 1/647）. Condusion Thoracoscopic cardiac surgical procedures for atrial septal defect occlusion, ventricular septal defectocclusion and mitral valve replacement is feasible and safe.