完全胸腔镜辅助下心脏手术体外循环的建立与管理

Establishment and management of cardiopulmonary bypass with totally video-assisted thoracoscopy in heart operation

目的总结完全胸腔镜辅助下心脏手术的体外循环建立和管理方法。方法分析103例心脏病患者借助电视胸腔镜进行房间隔缺损修补术、室间隔缺损修补术和二尖瓣置换术的体外循环建立方法、过程和术后结果。结果术中1例因调整股静脉插管位置时不慎将股动脉带出,出血约200ml,遂重新插入股动脉建立体外循环;术中1例因心包粘连,纵行切开胸骨第3肋间,横断第3、4肋骨,胸腔镜辅助下完成二尖瓣置换术;术后1例1周后出现残余漏,再次手术治疗。全组患者均痊愈康复出院。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,是常规心脏外科手术方法的一种补充,加强体外循环的应对措施和管理尤为重要。

Objective To summarize methods of establishment and management of cardiopulmonary bypass(CPB)with video-assisted thoracoscopy in heart operation.Methdos Analyze process of extacorporeal circulation and postoperative results with video-assisted thoracoscopy in ASD repair and VSD repair and mitral valve replacement.Results Cannulation of femoral artery was removed in one case by accident for adjusting position of arterial and venous cannulations.Hemorrhage about 200mL ensued after recannulation of femoral artery to establish CPB.Mitral valve replacement by third intercostal incision and third and cutting off the fourth and fifth ribs for severe pericardial adhesion was performed in one case with video-assisted thoracoscopy.Residual shunt was found in one case with VSD a week later after the first operation and reoperation was performed.All the cases got full recovery.Conclusion Heart operations can be done by applying CPB with totally video-assisted thoracoscopy.The method is safe and practicable and it is supplement for routine cardiac surgery.It is important to intensify measures and managements of CPB for ensuring surgical safety.