微创心脏不停跳心内直视手术的临床研究

Minimally invasive open-heart surgery in beating heart under cardiopulmonary bypass and light hypothermia

目的探讨微创心脏不停跳心内直视手术的外科技术和心肌保护的效果。方法应用浅低温体外循环心脏不停跳微创技术施行各种心内直视手术 13 8例。右胸前外侧小切口 5 8例 ,胸骨下段小切口 3 5例 ,胸骨全切口 45例。修补房室间隔缺损 97例 ,部分房室通道 8例 ,其他先心病 18例 ;左房粘液瘤 2例 ,风湿性心脏病二尖瓣成形 1例 ,换瓣 12例。结果手术死亡 1例 ,为术后低心排综合征 ,余无严重心律失常及空气栓塞 ,均痊愈出院 ,无远期死亡。结论微创心脏不停跳技术可安全有效地应用于大部分心脏手术。联合应用小切口手术的优点有切口小、创伤轻、出血少、恢复快、保持胸廓连续性和良好的心肌保护等效果 ,符合微创外科的原则。

Objective To evaluate the minimally invasive techniques and myocardial protective results of open heart surgery in beating heart.Methods 138 patients underwent minimally invasive open heart surgery in beating heart under cardiopulmonary bypass (CPB) with light hypothermia,of which 58 cases underwent right anterolateral thoracotomy,35 cases had lower sternotomy and full length sternotomy was performed in 45 cases.Among 138 cases,97 cases had repairment of atrial and ventricular septal defects,8 atrioventricularis communis,18 other congenital heart disease,two left atrial myxomas,one mitral valvuloplasty and 12 mitral value replacement.Results There were no severe arrhythmia and air embolism,but only one operative death because of low cardiac output.Other patients were discharged and had no late deaths.Conclusion Minimally invasive open heart operation in beating heart is a feasible,safe and effective technique for most of the cardiac surgery.Advantages of a right anterolateral thoracotomy or lower hemisternotomy in beating heart are obvious,including a smaller incision,less injury and blood loss,quick recovery,maintenance of the integrity of the bony cage and excellent myocardial protection.It is consistent with the idea of minimally invasive surgery.