Application of single utility port thoracoscopic combined with on-pump beating heart technique in open-heart surgery
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摘要:
目的 探讨单操作孔全胸腔镜联合心脏不停跳微创技术在心内直视手术中的应用效果。 方法 2015年9月—2018年12月，采用外周体外循环右胸单操作孔全胸腔镜联合心脏不停跳微创技术，完成多种心内直视手术41例。其中男性10例，女性31例；平均年龄(40.95±15.95)岁；平均体重(57.03±12.74)kg；手术病种和术式包括：房间隔缺损修补24例、部分房室管畸形矫治1例、膜部室间隔缺损修补2例、左心房肿瘤切除8例、右心房黏液瘤切除1例、三尖瓣Ebstein畸形改良Carpentier成型3例、三尖瓣关闭不全右心衰竭行瓣叶和人工环成形1例、二尖瓣置换术后三尖瓣关闭不全右心衰竭行三尖瓣生物瓣置换1例。同期手术三尖瓣叶成形5例、人工环成形3例、改良De Vega环缩12例、右肺静脉异位引流隔离1例。 结果 全组手术顺利完成，体外循环时间(81.18±39.07)min，腔静脉阻断时间(51.60±30.94)min，手术时间(177.15±45.05)min，呼吸机辅助时间(10.68±18.99)h，术后24 h引流量(241.86±64.38)mL，住院时间(13.33±12.43)d。术后主要并发症包括：右房切口出血二次进胸止血1例，肺部感染2例，呼吸衰竭气管切开1例，血红蛋白尿1例。术后无手术死亡病例，恢复顺利痊愈出院。术后随访2~5年，无残余分流和明显的瓣膜关闭不全，无晚期死亡和再手术病例。 结论 单操作孔全胸腔镜联合心脏不停跳微创技术，可安全、简便、有效地应用于多种心内直视手术。2种微创技术联合应用临床效应互补，既有切口美观和外科微创的优点，又能获得良好的心肌保护效果。 Abstract:Objective To investigate the application of single utility port thoracoscopic combined with on-pump beating heart minimally invasive technique in open-heart surgery. Methods From September 2015 to December 2018, 41 cases of various cardiac surgeries were performed by using single utility port thoracoscopic combined with on-pump beating heart minimally invasive technique. Among them, there were 10 males and 31 females; The average age was 40.95±15.95 years old. Surgical diseases and methods included: the repair of atrial septal defect in 24 cases, the correction of partial atrioventricular canal defect in 1 case, the repair of membranous ventricular septal defect in 2 cases, the resection of the left atrial tumour in 8 cases, the resection of right atrial myxoma in 1 case, the modified Carpentier annuloplasty for Ebstein anomaly in 3 cases, the leaflet and prosthetic ring annuloplasty for tricuspid regurgitation in right heart failure in 1 case, and the tricuspid bioprosthetic valve replacement for tricuspid regurgitation in right heart failure after the mitral valve replacement in 1 case. Results The operation in the whole group was successfully completed, the perioperative indicators showed: the time of cardiopulmonary bypass was (81.18±39.07) min, the time of vena cava blocking was (51.60±30.94) min, the operation time was (177.15±45.05) min, the time of respirator assistance was (10.68±18.99)h, the drainage volume within 24 hours after the operation was (241.86±64.38) ml, and the hospital stay was (13.33±12.43) d. The main postoperative complications included: the secondary invasion hemostasis for right atrial incision bleeding in 1 case, the pulmonary infection in 2 cases, the tracheotomy for respiratory failure in 1 case, and the hemoglobinuria in 1 case. There was no post-operative death, and the patient recovered well and was discharged. There was no residual patent ductus arteriosus or significant valve regurgitation, and no cases of late death or reoperation in the post-operative follow-up for 2-5 years. Conclusion It was safe, simple and effective for the single utility port thoracoscopic combined with on-pump beating heart minimally invasive technique to be applied to various open-heart surgeries. -
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