微创小切口体外循环心脏手术20例

Minimally Invasive Cardiac Surgery with Cardiopulmonary Bypass in 20 Patients

目的：探索心脏外科微创新技术。方法：２０例患者，行主动脉瓣替换术者经第２肋间正中横切口，行室缺修补、房缺修补及二尖瓣替换术者经后胸骨旁纵切口，儿童８～１０ｃｍ，成人１０～１２ｃｍ；升主动脉阻断１８～１１０ｍｉｎ。结果：术中术后出血量明显减少，其中８例（４０％）未输血。结论：微创小切口体外循环心脏手术有创伤小、恢复快、疼痛轻、出血少等优点，但其视野小，操作要求高，遇有特殊情况时处理较困难。

Objective:To examine the feasibility of minimally invasive cardiac surgery for CPB(cardiopulmonary bypass).Method:Operations of AVR,VSD,ASD and MVR were done respectively on 20 patients,among which the transverse incision was selected at the second intercostal space for AVR and the right parasternal longitudinal incision was chosen for VSD,ASD and MVR.The incision was 8～10cm for children,and 10～12cm for adult.The main aortic crossclamping time was 18～110min.Result:Bleeding during operation and postoperation decreased obviously and 8 cases without blood transfusion.Conclusion:Minimally invasive cardiac surgery with CPB achieves less bleeding,less pain and quick convalescent.But the vision is small and it requires a skilled technique.And it is difficult to manage in case of urgency.We suggest it be avoided on those cardiac function unsatisfied or the diagnose uncertained.