单中心开展全胸腔镜下体外循环心脏手术初期临床效果

Totally thoracoscopic cardiac surgery with cardiopulmonary bypass:a single-center short term clinical outcome

目的总结单中心开展全胸腔镜下体外循环心脏手术初期临床效果。方法2017年7月至2020年2月完成全胸腔镜下心脏手术198例,包括继发孔型房间隔缺损146例,部分型房室间隔缺损11例,左房粘液瘤36例,右房粘液瘤3例,左房恶性血管内皮瘤及左侧三房心各1例。其中男69例,女129例,年龄14~76(44.5±14.6)岁。术前心功能分级(NYHA)Ⅰ级76例,Ⅱ级98例,Ⅲ级24例;左室射血分数(LVEF)45~75(60.1±3.1)%,肺动脉收缩压(sPAP)24~89(53.2±12.9)mmHg。通过右侧胸壁3孔入路,股动静脉建立外周体外循环,在全胸腔镜下完成心脏手术。结果全组198例患者均治愈出院,患者手术时间1.9~7.7(4.0±0.9)h,体外循环时间46~270(101.7±30.0)min,主动脉阻断时间0~153(38.5±19.9)min。术后呼吸机辅助时间2.6~86.7(10.1±9.8)h,重症监护室时间14~125.5(23.6±15.0)h,术后胸腔引流量90~2540(293.6±157.9)ml,术后住院时间4~20(6.6±1.7)d。全组患者发生并发症11例,发生率为5.5%:包括术中中转开胸及扩大切口各1例,术后二次胸腔镜下止血3例,切口愈合不良3例,心室颤动、呼吸功能不全及脑水肿各1例。患者术后随访1~31(12.9±8.0)月,随访出现二尖瓣轻中度关闭不全1例,无再次手术及残余分流,患者随访心功能分级(NYHA)Ⅰ级152例,Ⅱ级46例,心功能明显好转。结论开展全胸腔镜下心脏手术临床效果良好,手术安全可行,手术创伤小及具有较好的近期疗效。

Objective To summarize the a single-enter short term clinical outcome of totally thoracoscopic cardliae surgery with curdiopulmonary bypass.Methods Clinical data of 198 cases undergone totally thoracoscopic cardiasc sungery from July 2017 to February 2020 in General Hospital of Northem Theater Command Was analyzed retrospeetivele,including 146 cases of atrial septal defect 11 cases of purtial atioventicular septal deet,36 cases of left arial myxoma,3 ceases of right atrial myxoma,1 cease of malignant hemangioendothelioma and 1 cease of left atrial cor triatriatum.There were 69 male and 129 female patients,aged from 14 to 76 years with s mean of(44.5±146)years.76 patients were in New York Heart Association(NYHA)funetional classⅠand 98 were in classⅡand 24 were in classⅢ.The left ventricular cjction fractions(LVEF)were from 45%to 75%with a mean of(60.1±3.1)%.And the systlie pulmonary artery pressures were from 24 to 89 with a mean of(53.2±12.9)mm Hg.Surgical procedures were performed through 3 port at the right chest wall and extracorporeal circulation was established with right femoral artery and a single 2 stage venus cannula in the right atrium.Results All the operations were completed successfully.The operative time was(4.0±0.9)hours.The mean extracorporeal circulation and aortic cross-clamp time were(101.7±30.0)minutes and(38.5±19.9)minutes,respectively.Mechanical ventilation time and intensive care unit stay were(10」±9.8)hours and(23.6±15.0)hours,respectively.Postoperation drainage quantity was(293.6±157.9)ml.The hospital days was(6.6±1.7)days.The operative complications occurred in 11 cases(5.5%),including 1 case of conversion to sternotomy,1 case of incision expand,3 cases of reoperation for bleeding,3 cases of the incision infection,1 cases of ventricular fibrillation,1 cases of respiratory insufficiency and 1 case of cerebral edema.The mean duration of follow-up was(12.9±8.0)months.During the period,1 case of mild-moderate mital valve incompetence occurred.There was no reoperation and residual shunt during the period of follow-up.During the period,152 patients were in NYHA functional class I and 46 were in classⅡ.Conclusion Totally thoracoscopic cardiac surgery with cardiopulmonary bypass is a feasible,safe and minimal invasive approach for the patients and may get good short term outcomes.