经右胸壁3孔完全胸腔镜心脏手术46例分析

Totally thoracoscopic cardiac surgery through three ports of the right chest:a summary of 46 cases

目的总结经右胸壁3孔完全胸腔镜下心脏手术的经验.方法2014年3月至2019年4月我科46例全胸腔镜经右胸壁3孔心脏手术,其中房间隔缺损26例,部分性肺静脉异位引流1例,室间隔缺损1例,二尖瓣病变置换8例,三尖瓣环成形8例,左心房黏液瘤2例.体外循环(extracorporeal circulation,ECC)采用浅、中低温,46例行股动、静脉插管.12例患者ECC中予以负压辅助静脉引流.16例手术采用含血停搏液灌注法心肌保护,心脏不停跳30例.结果46例患者无死亡且全部痊愈出院.ECC时间38~110 min,平均(53.4±28.6)min.升主动脉阻断时间28~94 min,平均(44.2±13.8)min.术后5~12 d痊愈出院.出院患者随访时间1~36个月,结果满意.结论完全胸腔镜ECC下心脏手术是微创、安全、可行的,围术期间需加强监护及防治各种并发症.

Objective To summarise the totally thoracoscopic cardiac surgery through three ports of the right chest.Methods From March 2014 to April 2019,46 patients undergone totally video-assisted thoracoscopic cardiac surgery through three ports of the right chest were reviewed.The surgical procedures included 26 cases of atrial septal defect,1 case of partial anomalous pulmonary venous connection,1 case of ventricular septal defect,8 cases of mitral valve replacement,8 cases of tricuspid valvuloplasty and 2 cases of left atarial myoxoma.Mild or moderate hypothotherm thermia was used.Extracorporeal circulation(ECC)cannulas were established through the femoral arteay and the femoral vein(n=46).Vacuum-assisted venous drainages(VAVD,-15^-30 mm Hg)were implemented in 12 patients during ECC and the drainage were staisfacrory.Myocardial protection was accomplished with perfusion using blood cardioplegc solution.30 cases were performed with beating heart surgery.Results No patient died and all the patients recovered and were discharged.ECC time was 38-110 min,average(53.4士28.6)min.Aortic cross-clamping was performed in 16 patients and the aortic crossclamping time was 28-94 min,average(44.2±13.8)min.The recovery took 5-12 days after surgery and the patients were followed up for 1-36 months.The clinical outcome was satisfactory.Conclusion Totally videoassised thoracoscope cardiac surgery is safe,feasible and minimally invasive.Close monitor and early treatment o f various complications during perioperative period should be strengthened.