全胸腔镜下手术治疗先天性心脏病

Video-assisted Thoracoscopic Cardiac Surgery for Congenital Heart Diseases

目的探讨胸壁打孔全胸腔镜下先天性心脏病手术的可行性。方法2004年10月-2008年8月,完成胸壁打孔全胸腔镜下先天性心脏病手术156例,其中单纯房间隔缺损79例、单纯室间隔缺损65例、主动脉窦瘤破裂合并室间隔缺损1例、右室双腔心合并室间隔缺损3例、房间隔缺损合并部分性肺静脉异位引流8例。右侧胸壁3孔,股动脉、静脉插管建立体外循环,特制的长阻闭钳阻闭升主动脉,冷晶体心脏停跳液顺行灌注保护心肌。结果手术均获成功,体外循环时间（74±28）m in,升主动脉阻闭时间（29±13）m in,术后呼吸机辅助时间（3.2±1.1）h,术后住院时间（6.1±1.2）d。术后并发症13例：7例右侧气胸,胸腔穿刺一次治愈;6例右腋下切口液化,伤口延期愈合。无严重并发症发生。全组术后5-7天超声心动图示房间隔、室间隔无残余分流,1例主动脉窦瘤破裂合并室间隔缺损修补术后主动脉瓣轻度返流,3例室间隔缺损合并右室双腔心术后右室流出道疏通满意;心电图示窦性心律,无房室传导阻滞。132例术后随访3个月-3年,其中95例〉12个月,无不适,心功能Ⅰ级。结论胸壁打孔全胸腔镜下手术治疗房、室间隔缺损安全可靠,创伤小,恢复快,美容效果好。

Objective To probe the feasibility of video-assisted thoracoscopic operation for congenital heart diseases. Methods From October 2004 to August 2008, 156 patients with congenital heart disease, including 79 cases of atrial septal defect （ASD）, 65 cases of ventricular septal defect （VSD）, 1 case of aortic aneurysm rupture combined with VSD, 3 cases of double chamber right ventricles （DCRV） combined with VSD, and 8 cases of partial anomalous pulmonary venous drainage, were treated totally under thoracoscope. Surgical procedures were performed through 3 trocars inserted at the right chest wall, and catheters were placed in the right femoral artery and vein to set up extracorporeal circulation. The ascending aorta was cross-clamped with long tailormade forceps and the myocardium was protected by coronary perfusion with cold crystalloid eardioplegia. Results All the thoracoscopic operations were completed successfully. The mean extracorporeal circulation and cross-clamping time were （74 ± 28） min and （29 ±13） min respectively. Postoperative ventilation was withdrawn in （3.2 ±1.1 ） h, and the patients were discharged from the hospital in （6.1 ±1.2） d. Thirteen of the patients had postoperative complications, including 7 cases of right pneumothorax （ healed by thoracentesis） , and 6 cases of fat liquefaction of the incision at the right axillary （delayed healing）. No severe complications occurred in this series. UCG performed 5 -7 days after the operation revealed no residual shunt of ASD or VSD; in the patients who had aortic aneurysm rupture combined with VSD, slight aortic valve regurgitation was detected after the neoplasty; and in the 3 patients with DCRV combined with VSD, the right ventricular outflow tract was patent. ECG showed sinus rhythm without AVB in the patients. Follow-up up to 3 months to 3 years were available in 132 cases （over 12 months in 95 cases）. During the period, no patient had complaints ; and the heart function was confirmed as level Ⅰ. Conclusions Video-assisted thoraeoscopie cardiac surgery is feasible, safe, and minimal invasive for patients with VSD or ASD, resulting in quick recovery and good cosmetic outcomes.