微创小切口非体外循环手术治疗先天性单纯冠状动脉瘘的单中心经验

Minimally invasive incision non-extracorporeal circulation in the treatment of congenital coronary artery fistula-a Single center experience

目的探讨微创小切口非体外循环手术治疗先天性冠状动脉瘘的可行性、安全性及临床效果。方法单纯先天性冠状动脉瘘病人49例,行微创小切口非体外循环冠状动脉瘘结扎手术,评估其可行性及优缺点。结果 49例均成功行微创小切口非体外循环冠状动脉瘘结扎手术,无院内死亡或术中转为正中开胸手术治疗。其中剑突下切口22例和胸骨旁切口20例,经心尖入路7例。手术时间30～125分钟,平均(67.45±22.69)分钟,术后机械通气时间2～12小时,平均(3.72±1.82)小时,ICU停留时间4～24小时,平均(9.67±5.43)小时。仅有1例病人术后有轻微的残余分流,术后半年复查时残余分流消失。所有病人均无心肌缺血。结论微创小切口非体外循环冠状动脉瘘结扎手术安全可行,术中视野暴露良好,手术时间短、恢复快、切口美观。

Objective To explore the feasibility,safety and clinical effect of minimally invasive incision non-extracorporeal circulation in the treatment of congenital coronary artery fistula. Methods Retrospective analysis from 49 patients with coronary artery fistula underwent minimally invasive incisionnon-extracorporeal circulation of ligation operation effect,to evaluate the feasibility and advantages and disadvantages. Results All of the 49 cases were successfully ligated with minimally invasive incision non-extracorporeal coronary artery fistula ligation operation,non hospital death or intraoperative transthoracic surgery was performed. The subcostal incision（22 cases） and the lateral sternal incision（20 cases）were the most commonly used minimally invasive incision approach,and less pericardial approach（ 7 cases）. The operation time was（67. 45 ± 22. 69） min（ 30 ～ 125 min）,the mechanical ventilation time was（3. 72 ± 1. 82）h（2 ～ 12 h）,and the duration of the ICU was（9. 67 ± 5. 43）h（4 ～ 24 h）. Only one patient had slight residual shunt after operation,and the residual shunt disappeared during six months after surgery. All patients had no myocardial ischemic. Conclusion Incision minimally invasive surgical ligation of CAF without cardiopulmonary bypass is safe and feasible,with good surgical field,shorter operation time,quick recovery and minimally incision.