全胸腔镜先天性心脏病房间隔缺损修补术与常规手术的比较

Comparison between the Totally Thoracoscopy Surgery and the Conventional Surgery in Repairing Congenital Atrial Septal Defect

目的：总结全胸腔镜下ASD修补术的经验。方法：32例患者均经心脏超声检查明确诊断为CHD ASD，分为A组（全胸腔镜）和B组（常规手术）。均在全麻气管插管下手术，A组经股动、静脉建立CPB；B组按常规方法建立CPB，均在CPB，主动脉阻断下完成ASD修补术。结果：手术时间、CPB时间、主动脉阻断时间、24 h胸腔引流量、气管插管留置时间比较，差异有统计学意义（P〈0.05）。手术过程顺利，术后恢复良好。除A组1例术后肺部感染，1例术后室颤，均及时治愈外，无其他严重之并发症发生。两组患者均在门诊随访1-20个月，心脏超声检查无残余漏、无中度以上的三尖瓣关闭不全。结论：全胸腔镜下ASD修补术可以获得与常规手术一样的疗效，但手术操作技术要求高、难度大，有一定的学习曲线。完全胸腔镜手术切口更小、更隐蔽，符合目前患者对美观的要求，是一种先进的微创心脏外科手术技术。

Objective：To summarise the experiences for repairing the congenital atrial septal defect in the total thoracoscopy surgery.Method： 32 cases were divided into 2 groups. In A group （the thoracoscopy）, 16 cases were adopted opening holes in thorax, the arterial catheter and one bipolar venous catheter were placed in the right femoral artery and femoral vein to set up CPB. In B group （conventional surgery）, 16 cases’ the breast bone was opened from up to down. The arterial catheter and two venous catheter were placed in the aortic, the superior vena cava and interior vena cava to set up CPB.Result： In A group, the time of operation, of CPB were both longer （P〈0.05）, the time of the aorta was cross-clamped and longer （P〈0.01）, the chest drainage in the first 24 hr was fewer （P〈0.05）, the time of the mechanical resoeration was shorter （P〈0.01）. Postoperative course was uneventful.Conclusion： The total thoracoscopic surgery for repairing atrial septal defect remarkably alleviates the wounds. It is also a advanced and minimal invasive technique in the cardiovascular surgeries.