完全胸腔镜下房间隔缺损修补术51例的临床体会

Clinical experience of atrial septal defect closer under total thoracoscopicy：a report of 51 cases

目的 总结完全胸腔镜下房间隔缺损（ASD）修补术的临床经验.方法 自2012年1月至2016年1月完全胸腔镜下行房间隔缺损修补术51例,其中男性22例、女性29例,年龄18～45（28.1±7.9）岁,体重42～64（47.3±5.2）kg;术前彩超证实均为继发孔房间隔缺损,ASD直径1.8～3.5（2.6±0.6）cm.全组采用股动、静脉插管建立体外循环,术中阻断主动脉及心脏停跳,完全胸腔镜下修补房间隔缺损.结果 全组无手术死亡,51例患者中50例（98.0％）手术顺利进行,1例（2.0％）扩大切口完成.主动脉阻断时间22～35（28.1±3.1）min,呼吸机辅助时间4～6（4.6±0.3）h.术后46例（46/51,90.2％）随访6～12个月,无残余分流,无近期死亡.结论 完全胸腔镜下房间隔缺损修补术具有创伤小、恢复快、安全可靠、切口美观的特点,但技术要点需多次操作方可熟练掌握.

Objective To sum up the clinical experience of atrial septal defect （ASD） closer under total thoracoscopicy.Methods 51 patients with ASD under total thoracoscopicy operation from 2012.01 to 2016.01,22 males and 29 females,aged from 18-45 （28.1±7.9）years.The weight of these patients ranged from 42-64 （47.3± 5.2）kg.The diameter of these ASD ranged from 1.8-3.5（2.6±0.6）cm.All patients adopt femoral artery and femoral venous to establish extracorporeal circulation,to block aorta and stop beating heart,to closer ASD under total thoracoscopicy.Results All patients were completed successfully.1 patient （2.0%） were expand Incision to complete.The time of aorta block 22-35（28.1±3.1）min,the time of breathing machine application 4-6（4.6±0.3）h.46 patients were followed up for 6-12 months,there were neither residual shunt nor recent death.Conclusion Atrial septal defect （ASD） closer under total thoracoscopicy is a safe and effective treatment,there were advantages of small trauma and rapid recovery,the incision is beautiful,operation more times can master the operation points.