胸腔镜下室间隔缺损修补术

Video-assisted thoracoscopic surgery in the closure of ventricular septal defect

目的 探讨胸腔镜下室间隔缺损修补术。 方法 16例先天性心脏病 (男 10例 ,女 6例 )。年龄 (6～ 2 7)岁。 (14± 7)岁 ,体重 (17～ 6 7)kg ,(38 5± 16 8)kg。采用股动静脉插管 ,在患者右侧第四肋间胸骨旁、第四肋间腋中线、第七肋间腋中线各打一个直径 1cm～ 3cm的孔 ,经第四肋间腋中线插入上腔静脉插管 ,建立体外循环 ,阻闭升主动脉 ,冠脉冷灌 ,心脏停搏 ,切开并悬吊右心房 ,显露三尖瓣及室间隔缺损 ,缝合室间隔缺损 ,缝合右心房切口 ,开放升主动脉。 结果 16例手术均获成功 ,主动脉阻闭时间 (2 7～ 6 7)min ,(43± 13)min。体外循环时间 (6 6～ 16 8)min ,(95± 33)min。术后心脏杂音消失 ,心脏超声检查示无心内分流。 结论 胸腔镜下可完成室间隔缺损修补术的全部心内操作。也为室间隔缺损修补术提供了另一种选择。

Objective To study the application of video-assisted thoracoscopy in the closure of ventricular surgery. Methods Sixteen patients (10 male and 6 female)underwent the operation for the closure of a ventricular septal defect.The patients ranged in age from 6 to 27 years,(14±7)years.Three minithoracotomies with diameter of 2 to 3 cm were made in the fourth intercostal space of right parasternum and the fourth,seventh intercostal space of right middle axillary line respectively.With the assistance of thoracoscopy,caval cathter was inserted into the superior vena cava via the orifice in the 4th intercostal space.Femorofemoral extracorporeal circulation was built.The aorta was cross-clamped and the myocardium was protected by coronary perfusion with cold cardioplegia.Right atrium was opened and traction suture was made to expose the defect. Results Primary closure of defects was performed successfully in all patients.The duration of aortic cross-clamp and extracorporeal circulation ranged from 27 to 67 min(43±13)min and from 66 to 168 min(95±33)min respectively.Cardiac murmur disappeared postoperatively.Echocardiogram showed there was no residual shunt. Conclusions Vidio-assisted thoracoscopic surgery is a new choice to perform the closure of ventricular septal defect.Closure of atrial or ventricular septal defect can be completely done with the assistance of video-assisted thoracoscopy.