经右胸前外侧小切口左心房粘液瘤切除术的疗效分析

Clinical Outcomes of Left Atrial Myxoma Resection via Right Anterolateral Minithoracotomy

目的分析经右胸前外侧微创小切口行左心房粘液瘤切除术的临床疗效和安全性。方法回顾性分析2011年1月至2013年10月泸州医学院附属医院胸心外科施行经右胸前外侧微创小切口左心房粘液瘤切除术9例患者的临床资料,其中男2例、女7例,年龄37~62（51±9）岁。采用右胸前外侧微创小切口（4~6 cm）,经股动、静脉及上腔静脉建立体外循环,经胸阻断升主动脉,灌注冷血心脏停博液,行左心房粘液瘤切除术。结果手术均获成功,无死亡病例。全组总手术时间210~310（260±33）min,升主动脉阻断时间23~50（37±9）min,体外循环时间60~87（71±9）min,术后呼吸机辅助时间6~14（9.0±2.5）h,住ICU时间17~26（20±3）h,术后心包、纵隔引流量100~650（376±190）ml,术后切口长度4.5~6.0（5.3±0.6）cm。术后门诊随访1~30个月,复查心脏彩色超声心动图无复发病例。结论经右胸前外侧微创小切口行左心房粘液瘤切除术安全可行,疗效确切。

Objective To investigate clinical outcomes and safety of minimally invasive left atrial myxoma（LAM） resection via right anterolateral minithoracotomy（ALMT）. Methods Clinical data of 9 patients who underwent minimally invasive LAM resection via right ALMT in the Affiliated Hospital of Luzhou Medical College from January 2011 to October 2013 were retrospectively analyzed. There were 2 male and 7 female patients with their age of 37-62（51±9） years. The operation was performed through a small（4-6 cm） right ALMT incision. Femoral artery and vein and superior vein were cannulated to establish cardiopulmonary bypass（CPB）. Transthoracic clamp was used for ascending aortic clamping. Antegrade cold blood cardioplegia was infused for myocardial protection. LAM was resected through right atriotomy trans-septal approach. Results All the operations were successfully performed without in-hospital death. Operation time was 210-310（260±33） minutes, aortic cross-clamping time was 23-50（37±9） minutes, CPB time was60-87（71±9） minutes, postoperative mechanical ventilation time was 6-14（9.0±2.5） hours, and length of ICU stay was17-26（20±3） hours. Postoperative mediastinum drainage was 100-650（376±190） ml. Mean length of right ALMT was 4.5-6.0（5.3±0.6） cm. All the patients were followed up for 1 to 30 months,and echocardiography showed no LAM recurrence. Conclusion Minimally invasive LAM resection via right ALMT is safe and feasible with satisfactory clinical outcomes.