| 摘要: |
| ［摘要］ 目的 分析全胸腔镜微创心脏手术的临床疗效。方法 回顾性分析广西壮族自治区人民医院心胸血管外科2013年1月至2021年5月完成的206例全胸腔镜微创心脏手术的临床资料。其中房间隔缺损109例，伴三尖瓣中、重度关闭不全32例；二尖瓣瓣膜病58例，伴三尖瓣中、重度关闭不全28例，合并血栓6例；单纯三尖瓣关闭不全22例；左房黏液瘤17例。结果 所有患者手术获得成功，1例扩大切口改为胸腔镜辅助小切口，无二次开胸止血，无手术死亡。全组无术后残余漏、瓣周漏。手术时间(268.8±70.6)min，体外循环时间(140.3±64.7)min，升主动脉阻断时间(98.1±56.3)min，术中出血量(230±140)ml。术中用血浆(232±245)ml，红细胞(2.1±1.5)U。ICU监护时间(28.6±22.4)h，呼吸机辅助时间(16.4±10.3)h。术后引流(598±210)ml，术后输血浆(446±330)ml。平均术后4.8 d拔除引流管，术后住院时间(12.6±4.7)d。56.8%(117/206)的患者在住院期间未输血。术后随访1～60个月，患者心功能良好，NYHA分级均为Ⅰ～Ⅱ级。结论 全胸腔镜微创心脏手术具有损伤小、易接受和恢复快等优点，值得临床推广。 |
| 关键词: 全胸腔镜 心脏病 微创心脏手术 |
| DOI：10.3969/j.issn.1674-3806.2023.04.13 |
| 分类号:R 654.2 |
| 基金项目:广西卫生健康委资助项目（编号：Z-A20220090）；广西科技厅自然科学基金资助项目（编号：2016GXNSFAA380079） |
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| Analysis on the clinical efficacy of minimally invasive cardiac surgery under total thoracoscopy |
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ZHANG Ze, JIANG Wei, LI Si-cong, et al.
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Youjiang Medical University for Nationalities, Baise 533000, China
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| Abstract: |
| ［Abstract］ Objective To analyse the clinical efficacy of minimally invasive cardiac surgery under total thoracoscopy. Methods A retrospective analysis was performed on 206 patients who underwent minimally invasive cardiac surgery under total thoracoscopy in the Department of Thoracic and Cardiovascular Surgery of the People′s Hospital of Guangxi Zhuang Autonomous Region from January 2013 to May 2021, including 109 cases of atrial septal defect among whom 32 cases were complicated with moderate to severe tricuspid regurgitation, 58 cases of mitral valve disease among whom 28 cases were complicated with moderate to severe tricuspid regurgitation and 6 cases were complicated with thrombus, 22 cases of simple tricuspid regurgitation and 17 cases of left atrial myxoma. Results All the operations were performed successfully. One case of enlarged incision was changed to thoracoscopic assisted small incision but there was no secondary thoracotomy for hemostasis. There was no perioperative mortality. There was no residual leakage or perivalvular leakage. The operation time was (268.8±70.6)min. The duration of extracorporeal circulation was (140.3±64.7)min. The duration of ascending aorta occlusion was (98.1±56.3)min. The intraoperative blood loss was (230±140)ml. The amount of plasma used during operation was (232±245)ml. The amount of red blood cells used during operation was (2.1±1.5 )U. The length of stay in the Intensive Care Unit(ICU) was (28.6±22.4)h. The auxiliary time of ventilator was (16.4±10.3)h. The postoperative drainage volume was (598±210)ml. The postoperative plasma transfusion was (446±330)ml. The average time to remove the drainage tube after operation was 4.8 days. The postoperative hospital stay was (12.6±4.7)days. Fifty-six point eight percent(117/206) of the patients did not receive blood transfusion during hospitalization. All the patients were followed up for 1 to 60 months after operation, and the cardiac function of the patients was good, and their New York Heart Association(NYHA) grades were Ⅰ to Ⅱ. Conclusion Minimally invasive cardiac surgery under total thoracoscopy has the advantages of small damage, easy to accept and quick recovery, and should be recommended for a wider use in clinical practice. |
| Key words: Total thoracoscopy Heart disease Minimally invasive cardiac surgery |
