全胸腔镜下成人房间隔缺损修补手术20例临床分析

摘要： 目的??回顾性分析全胸腔镜下行20例成人房间隔缺损修补手术的临床效果，总结全胸腔镜下心脏手术经验。方法?该院自2014年3月-2016年8月，采用右侧股动脉、股静脉插管建立周围体外循环，主动脉根部顺行灌注冷血停跳液保护心肌，在右侧胸壁打3孔完成成人房间隔缺损修补心脏手术20例，分析手术时间、主动脉阻断时间、体外循环时间、呼吸机辅助时间、胸腔引流情况、住院天数和并发症等临床资料。结果?全组患者手术时间为3.5～5.0 h，平均（3.8±0.5）h；升主动脉阻断时间为28～46 min，平均（29.8±8.2）min；体外循环时间为86～108 min，平均 （80.6±11.5） min；呼吸机辅助时间5～8 h，平均（6.0±0.8）h；胸腔引流量100～260 ml，平均（150.0±35.0）ml；术后住院时间6～9 d，平均（6.5±1.2）d。全组患者无手术死亡，术后无残余分流发生，有1例患者腹股沟伤口脂肪液化，予以加强伤口换药处理；1例患者胸腔积气，予以穿刺后好转；1例患者因右侧胸腔粘连改为胸腔镜辅助，患者恢复顺利，全组无严重并发症发生。术后3～5天超声心动图示手术效果满意，患者顺利出院。随访1～28个月，无残余分流，无下肢静脉血栓形成，心功能均为Ⅰ级。结论?全胸腔镜下成人房间隔缺损修补心脏手术安全可行，手术创伤小，切口美观，术后引流少，患者恢复快。
Abstract: Objective?To analyze the clinical effect through 20 adult atrial septal defect repair cases with totally thoracoscopic and summarize the experience of totally thoracoscopic cardiac surgeries.?Methods?From March 2014 to August 2016, 20 adult atrial septal defect cases repaired by totally thoracoscopic were enrolled in the study. Extracorporeal circulation was established by inserting artery pump tubes into the right femoral artery and vein tubes in to the right femoral vein, cold blood cardioplegia was perfused ante gradely through the aortic root in order to protect the myocardium, then atrial septal defect repair cardiac surgeries were implemented by perforating 3 holes through the right chest wall. Analyze the operation time, aortic cross clamping time, CPB time, amount of drainage, hospital stay, postoperative complications and so on.?Results?The operation time was 3.5 ~ 5.0 h, and the average level was (3.8 ± 0.5) h. The blocking duration of the ascending aorta ranged from 28 to 46 min, and the average level was (29.8 ± 8.2) min. The duration of extracorporeal circulation ranged from 86 to 108 min, and the average level was (80.6 ± 11.5) min. Ventilation time ranged from 5 to 8h, and the average level was (6.0 ± 0.8) h. The amount of thoracic drainage ranged from 100 to 260 ml, and the average level was (150.0 ± 35.0) ml. Hospital stay ranged from 6 to 9 days, and the average level was (6.5 ± 1.2) days. All the operations were completed successfully. There were no in-hospital death or serious post-operative complications. UCG performed 3~5 days after the operation revealed surgical results were satisfactory. Follow up to 1~28 months were available in all cases. During the period, the heart function was confirmed as Ⅰ level.?Conclusion?Adult atrial septal defect repair surgeries with totally thoracoscope is safe and reliable and have advantages of less injury, rapid discovery, light pain, and less postoperative drainage.