经右胸全胸腔镜下行心房粘液瘤切除术的临床研究

A clinical study of atrial myxoma resection under total thoracoscopy using a right-side approach

目的:探讨经右胸全胸腔镜下体外循环停跳下心房粘液瘤切除术的可行性,评价其临床安全性及应用价值。方法:回顾性分析2011年12月至2018年12月,重庆市人民医院(中国科学院大学重庆医院)接受完全胸腔镜下心脏粘液瘤切除术的患者32例,其中,左心房粘液瘤30例,右心房粘液瘤2例,男14例,女18例。术前心功能分级(New York Heart Association,NYHA),Ⅰ级8例,Ⅱ级17例,Ⅲ级7例。股动静脉插管、右颈内静脉插管引流建立体外循环,全胸腔镜下经右胸副操作孔阻断升主动脉,心脏停跳后经右心房和房间隔入路行粘液瘤切除。结果:无围术期死亡,手术时间[(176.13±8.12)min],体外循环时间[(132.19±6.45)min],主动脉阻断时间[(70.94±3.80)min]。术后48h出血量[(283.71±44.28)mL];10例患者术中输血,输血率31.25%;中位输血量2(0,4)u。术中行食道超声检查及出院前复查心脏超声,心脏粘液瘤均完整切除,无残余心脏粘液瘤。各瓣膜功能良好。目前随访期间患者无再发心脏粘液瘤,无心脏瓣膜疾病再次心脏手术,无严重心脑血管并发症。结论:体外循环下经右胸全胸腔镜下行心房粘液瘤切除安全可行,其临床疗效确切,且手术创伤和术后瘢痕更小,利于术后患者恢复。

Objective:To explore the feasibility of atrial myxoma resection under total thoracoscopy using a right-side approach through a cardiopulmonary bypass(CPB),and to evaluate its clinical safety and application value.Methods:A retrospective analysis was performed on 32 patients(14 males,18 females) who had undergone cardiac myxoma(left atrial myxoma in 30 cases and right atrial myxoma in 2 cases) resection under total thoracoscopy from December 2011 to December 2018 in Chongqing People ’ s Hospital(Chongqing General Hospital,University of Chinese Academy of Sciences).The preoperative New York Heart Association classification of cardiac function showed the following:grade Ⅰ in 8 cases,grade Ⅱ in 17 cases,and grade Ⅲ in 7 cases.A CPB was established by intubation of the femoral artery and vein and intubation of the right internal jugular vein for drainage;the ascending aorta was blocked under total thoracoscopy using a right-side approach;the myxoma was resected through the right atrial and interatrial septal approach after cardiac arrest.Results:No perioperative death occurred.The time of operation,CPB time,and time of aortic occlusion were(176.13±8.12)min,(132.19±6.45)min,and(70.94±3.80)min,respectively.The volume of blood loss up to 48 h after operation was(283.71±44.28)mL;10 patients received intraoperative blood transfusion,resulting in a transfusion rate of 31.25%;the median transfusion volume was 2 units(range:0-4).Intraoperative transesophageal ultrasonography and pre-discharge echocardiography reexamination suggested that the cardiac myxoma was completely removed without any residue.All of the cardiac valves functioned well.During the follow-up period,there was no recurrent cardiac myxoma,second operations due to valvular diseases,or any serious cardiovascular and cerebrovascular complications.Conclusion:Atrial myxoma resection under total thoracoscopy using a right-side approach through a CPB is safe and feasible,with definite clinical effect and minimal surgical trauma and postoperative scars,which is beneficial to the recovery of patients after operation.