胸腔镜微创心脏手术453例早期临床疗效的单中心回顾性研究

Short-term effect of minimally invasive thoracoscopic cardiac surgery in 453 patients:A retrospective study in a single center

目的 分析胸腔镜下微创心脏手术的单中心早期临床疗效。方法 回顾性分析2017年7月—2022年2月在北部战区总医院心血管外科行胸腔镜微创心脏手术患者的临床资料。结果 共纳入患者453例,其中男150例、女303例,平均年龄(42.2±14.6)岁。主要病种包括继发孔型房间隔缺损314例,部分型房室间隔缺损26例,心脏肿瘤105例。全组患者无围术期死亡,平均手术时间(3.9±0.8)h,体外循环时间(101.2±34.0)min,主动脉阻断时间(42.1±25.1)min,术后呼吸机辅助时间(11.6±9.4)h,术后重症监护室停留时间(22.6±13.9)h,术后住院时间(6.0±1.7)d。全组18例(4.0%)患者发生并发症,包括中转开胸2例,术中扩大切口3例,术后胸腔镜下二次止血3例,再次手术1例,切口感染4例,呼吸功能不全及脑血管意外各2例,心室颤动1例。术后随访(22.6±15.4)个月,随访期间死亡1例,出现中度二尖瓣关闭不全4例,轻中度二尖瓣关闭不全及中度三尖瓣关闭不全各1例。结论 胸腔镜下微创心脏手术安全有效,手术创伤小及并发症少,近期疗效满意。

Objective To analyze the short-term outcomes of cardiac surgery via minimally invasive approach under thoracoscope in a single-center.Methods The clinical data of patients who underwent cardiac surgery via minimally invasive approach under thoracoscope between July 2017 and February 2022 were retrospectively analyzed.Results A total of 453 patients were enrolled,including 150 males and 303 females at an average age of 42.2±14.6 years.The main disease types included atrial septal defect in 314 patients,partial atrioventricular septal defect in 26 patients,and cardiac tumor in 105 patients.There was no death during the perioperative period.The mean operative time was 3.9±0.8 h,cardiopulmonary bypass time was 101.2±34.0 min,aortic occlusion time was 42.1±25.1 min,ventilator assistance time was 11.6±9.4 h,ICU stay time was 22.6±13.9 h and postoperative hospital stay was 6.0±1.7 d.Intraoperative and postoperative complications occurred in 18(4.0%)patients,including 2 patients with conversion to sternotomy,3 with incision expand,3 with reoperation for bleeding,1 with of redo operation,4 with incision infection,2 with respiratory insufficiency,2 with cerebrovascular accident,and 1 with ventricular fibrillation.The follow-up time was 22.6±15.4 months,during which 1 patient died,4 patients had moderate mitral regurgitation,1 patient had mild-moderate mitral regurgitation,and 1 patient had mild-moderate tricuspid regurgitation.Conclusion Minimally invasive cardiac surgery under thoracoscope is safe with small invasions and few complications,and has satisfactory short-term outcomes.