全胸腔镜心脏手术的并发症及防治分析

目的 分析探讨154例全胸腔镜心脏手术并发症.方法 在周围体外循环下采用电视胸腔镜完成心脏手术154例,其中房间隔缺损修补术64例,室间隔缺损修补术77例,二尖瓣置换术13例.结果 房、室间隔缺损修补术时间为28～132 min;二尖瓣置换术为96～157 min;整个手术时间为2.6～5.6 h,平均为3.6 h.术中术后有并发症20例（12.98%）,术中扩大切口6例（3.90%）,其中横断胸骨3例;术中右室破裂1例,术后二次止血4例（2.60%）,肝破裂1例,右小腿骨筋膜室综合征2例,肺部感染2例;室缺残余漏2例,术口逾期愈合2例,全组死亡1例（0.69%）.结论 电视胸腔镜下行简单心脏病手术创伤小、手术效果较好,但要求操作医师操作技术熟练,否则在不熟练下操作会增加并发症发生率.

Analysis of prevention and treatment of the complication of complete video-assisted thoracoscopic cardial surgery

Objective To summarize and analyze the prevention and treatment of the complication of videoassisted thoracoscopic cardial surgery for 154 patients. Methods Under peripheral extracorporeal circnlation （ECC）, the video-assisted thoracoscopic cardial surgery were completed in 154 patients, Among them repair of atrial septal defects were performed in 64 patients, repair of ventricular septal defect in 77 patients, and mitral valve replacement in 13 patients. Results Repair time of atrial septal defects and ventricular septal defect ranged from 28 minutes to 132 minutes ; while the time of mitral valve replacement ranged form 96 minutes to 157 minutes. The oper- ation time ranged form 2. 6 hours to 5.6 hours, with a average of 3.6 hours. After operation, 20 patients had compli- cation （12.98%）, incision were enlarged during operation in 6 patients （3.90%）. Among them, transverse breast- bones break occurred in 3 patients; right ventricle rupture during operation in one patient ; twice hemostasis after op- eration in 4 patients （2. 60% ） ; liver ruptured in one patient; compartment syndrome of the right lower leg in 2 patients ; hmg infection in 2 patients ; residual shunt of ventricle in 2 patients ; operating incision delayed healing in 2 patients. 1 patient died in the whole group （0. 69% ）. Conclusion Simple cardial operation can be performed under video-thoracoscope. It has advantages of minimum invasion, and good cosmetic effect. It is a feasible method, but it needs plenty of practicing operations with endoscope, otherwise, unskillful operation will increase the occurrence of complication.