全胸腔镜技术在左房黏液瘤外科治疗中的临床应用

The clinical application of totally thoracoscopic technique in surgical treatment of left atrial myxoma

目的总结采用全胸腔镜技术在左房黏液瘤外科治疗中应用的临床经验与效果。方法2018年9月至2022年2月,北部战区总医院应心外科应用全胸腔镜技术为97例左房黏液瘤患者行微创切除手术,其中男性24例,女性73例,年龄17~77(56.9±10.1)岁。其中合并二尖瓣中度关闭不全7例,三尖瓣中度关闭不全6例,三尖瓣重度关闭不全1例。采用右侧胸壁3孔入路,股动静脉建立外周体外循环,阻断升主动脉,冷血心脏停搏液顺灌保护心肌,在全胸腔镜下完成心脏手术。结果本组无围术期死亡病例,全组患者手术时间为2.5~7.7(4.0±0.7)h,体外循环时间46~204(106.8±29.6)min,主动脉阻断时间12~130(47.9±21.8)min,术后机械通气时间及ICU时间分别为3.0~86.1(13.8±11.1)h和15.2~109.7(23.2±13.1)h,术后住院时间为4~14(6.0±1.6)d。全组4例患者发生并发症,包括延长胸部切口2例,术后出现Ⅱ型呼吸衰竭及脑水肿各1例。患者术后随访1~41(17)月,随访期间出现二尖瓣轻中度关闭不全1例,无肿瘤复发,心功能恢复良好。结论全胸腔镜技术经右心房—房间隔切口可完整切除左心房黏液瘤,并可同期行二尖瓣及三尖瓣手术,手术安全有效,手术创伤小,美容效果良好,术后恢复快,可在左心房黏液瘤外科治疗中推广应用。

Objective To summarize the clinical experience and outcome of totally thoracoscopic technique in surgical treatment of left atrium myxoma.Methods Clinical data of ninety-seven cases undergoing totally thoracoscopic cardiac surgery for left atrium myxoma from September 2018 to February 2022 in General Hospital of Northern Theater Command was analyzed retrospectively.There were 24 males and 73 females,aged from 17 to 77 years with the mean age of 56.9±10.1 years.7 patients were complicated with moderate mitral regurgitation,6 patients were complicated with moderate tricuspid regurgitation,and 1 patient was complicated with severe tricuspid regurgitation,respectively.Femoral arterio-venous cannulation was used to establish cardiopulmonary bypass.The operation was performed through 3 port at the right chest wall,aortic cross clamp and thoracoscopic-assisted.A cold antegrade blood cardioplegia was applied to protect myocardium.Results There were no perioperative deaths in all cohorts.The total operative time was(4.0±0.7)hours.The mean extracorporeal circulation and aortic cross-clamp time were(106.8±29.6)minutes and(47.9±21.8)minutes,respectively.Mechanical ventilation time and intensive care unit stay were(13.8±11.1)hours and(23.2±13.1)hours,respectively.The postoperative hospital stay was(6.0±1.6)days.Complications occurred in 4 patients in the whole group,including 2 cases of incision expand,1 case of type II respiratory failure and 1 case of cerebral edema,respectively.The mean duration of follow-up was 17(7,33)months.During the follow-up period,1 case had mild-moderate mitral regurgitation,and no tumor recurrence was found.Conclusion Totally thoracoscopic technique can completely remove the left atrial myxoma via right anterolateral thoracotomy,and simultaneously perform the mitral and tricuspid valve surgery.The operation is safe and effective,with small surgical trauma,good cosmetic effect,and rapid postoperative recovery,which is worthy of clinical application.