胸部小切口心脏不停跳心内直视手术在先天性心脏病中的应用

目的 探讨胸部小切口心脏不停疏心内直视手术在治疗先天性心脏病中的应用价值.方法 经胸部小切口心脏不停跳行先天性心脏病手术383例.经右胸前外侧小切口299例,右腋下小切口48例,胸骨正中下段小切口36例.选择同期正中切口心脏停跳手术治疗的先天性心脏病患者100例为对照组进行比较.结果 两组患者均无手术死亡.小切口不停跳组手术切口长度、CPB时间、手术时间、术后呼吸机辅助时间、术后引流量、术后输血量、术后纵隔感染及胸骨畸形等并发症均少于对照组(均P<0.05).术后住院时间和对照组相比差异无统计学意义(P>0.05).结论 胸部小切口心脏不停跳适用于简单的先天性心脏病手术,具有切口隐蔽美观、术后渗血少、切口感染发生率低、无胸骨畸形、心肌保护效果好、显著缩短体外循环时间等优点.     

小儿微创不停跳心内直视手术的应用

目的：介绍微创不停跳心内直视手术在小儿先天性心脏手术中的应用体会。方法：选择小儿一般先天性心脏病28例,其中房间隔缺损16例,室间陋缺11例,室间隔缺损合并右流出道狭窄1例。均采用右胸小切口经右第四肋间在浅低温体外循环不停跳下手术。结果：无手术并发症和手术死亡。结论：右胸小切口浅低温不停跳下进行小儿心内直视损伤小,恢复快,简便,安全,美容效果好。     

心脏不停跳心内直视手术的监测及护理进展

体外循环心脏不停跳心内直视手术是近20年来心血管外科成就显著的技术,是心内手术的心肌保护选择的最佳方案之一.近年来,随着心脏不停跳手术整体水平的提高,手术中的护理技术及经验亦日趋成熟、完善,现将心脏不停跳心内直视手术的术中护理进展综述如下:     

心脏不停跳心内直视手术的监测及护理进展

体外循环心脏不停跳心内直视手术是近20年来心血管外科成就显著的技术,是心内手术的心肌保护选择的最佳方案之一.近年来,随着心脏不停跳手术整体水平的提高,手术中的护理技术及经验亦日趋成熟、完善,现将心脏不停跳心内直视手术的术中护理进展综述如下：     

微创心脏不停跳修补房间隔缺损108例

目的：探讨微创心脏不停跳在房间隔缺损治疗中的应用。方法：1998-05～2001-06期间108例房间隔缺损采用微创心脏不停跳手术治疗。用右前外乳腺下弧形、右腋下斜行及胸骨正中小切口，切口长5～10cm，平均8．1cm。采用补片修补27例，直接缝合者8l例。结果：108例病人术后无低心排综合征，痊愈出院。术后随诊满意。结论：微创心脏不停跳治疗房间隔缺损，手术切口小、心肌保护好、损伤小、安全、恢复快、美观、效果好。     

右胸小切口心脏不停跳手术矫治先天性心脏病疗效分析

目的：探讨右胸小切口心脏不停跳手术在先天性心脏病中的应用。方法：回顾性分析1995／2008年完成的右胸小切口心脏不停跳先心脏病手术347例，选择同期正中切口心脏停跳下先心病手术100例为对照组。结果：小切口不停跳组手术切口长度、CPB时间、手术时间、术后呼吸机辅助时间、术后引流量、输血量、胸骨感染及畸形等并发症均少于对照组（P〈0．05）。结论：右胸小切口心脏不停跳手术具有切口隐蔽美观、无胸骨畸形、心肌保护效果好、体外循环时间较短等优点。     

浅低温心脏不停跳心内直视手术215例临床分析

目的：总结215例浅低温体外循环下不停跳心内直视手术的临床应用经验。方法：215例行心脏不停跳心内直视手术病例,并行循环者阻断上下腔静脉而不阻断升主动脉,不使用心脏停跳液;逆行灌注者,阻断升主动脉后经冠状静脉窦逆行持续灌注机器氧合血,鼻咽温度在（33±1）℃,均在心脏空跳下完成心内直视手术。结果：心脏手术完毕后顺利停机,术后血液动力学平稳,低心输出量综合征发生率低,无1例发生神经系统并发症及空气栓塞,早期死亡率0．93％（2／215）。结论：浅低温体外循环下不停跳心内直视手术技术安全可行,是一种接近生理状态的心肌保护方法,可应用于绝大部份心内直视手术。     

海拔3700米先天性心脏病体外循环外科手术12例

目的：探讨西藏地区先天性心脏病体外循坏心脏不停跳与心脏停跳下心内直视手术的方法和治疗效果。方法：12例先天性心脏病人中8例采用浅低温体外循环心脏不停跳下心内直视手术,4例心脏停跳下心内直视手术。结果：12例病人均治愈,结论：海拔3700米地区绝非心脏外科手术禁忌,加强心肌保护,做好围手术期的综合治疗,广泛开展高原心脏外科手术是完全可能的。     

心脏不停跳心内直视手术对心肌保护作用的临床研究

浅低温心脏不停跳心内直视手术能够缩短心肌缺血时间,我们将此方法与低温心脏停跳心内直视手术进行了对比研究,旨在探讨不停跳心内直视手术对心肌的保护作用,为临床应用提供理论依据。1对象和方法1．1研究对象实验组（心脏不停跳心内直视手术组）10例,男3例,女7例;年龄20±15．5岁;其中房间隔缺损3例,空间隔缺损3例,二尖瓣置换3例,部分性心内膜垫缺损1例。同期选择16例病人作为对照组（低温心脏停跳心内直视手术组）,男6例,女10例;年龄18±12.6岁;其中房间隔缺损3例,室缺9例,二尖瓣置换3例,主动脉窦瘤1例。1．2研究方法1．…     

右侧小切口心内直视手术的护理配合

传统上心血管手术是在全麻体外循环下，经胸骨正中切口，直视下进行手术矫治。随着外科技术不断的改进、手术经验的积累、仪器设备的完善，医师和患者对手术要求不再仅仅局限于对心脏畸形的矫治，切口美容的要求也越来越高。近年开展的右侧开胸和胸骨下段入路等小切口、微创心脏直视手术，满足了部分医师和患者的要求。我院2001年开展右侧胸小切口体外循环心内直视手术23例，现将术中护理配合总结报告如下。     

胸部小切口心脏直视手术

目的：介绍几种体外循环下胸部小切口心脏直视手术的经验。方法：161例心脏疾病患者采用右腋下、右前外侧胸、胸骨右侧旁及胸骨下段小切口,在体外循环下施行心脏直视手术。病种包括房间隔缺损、室间隔缺损、法乐四联症、二尖瓣狭窄或／并关闭不全、二尖瓣狭窄并三尖瓣关闭不全及其他畸形,包括肺动脉口狭窄、动脉导管未闭及永存左上腔静脉等。结果：术后161例患者中2例（1．2％）分别死于消化道溃疡出血及重型肺炎。1例并发胸骨后出血、Ⅲ度房室传导阻滞、室间隔缺损修补术后残余分流;1例右侧胸腔积液,经处理后均康复出院。结论：以上各小切口开胸行心脏直视刘安全、有效的。术野显露好,病变矫正满意,创伤小,并发症少,痛苦轻,恢复好,美观效果亦好。临床 可根据具体情况选择应用。     

小切口微创二尖瓣手术的临床研究

[目的]比较右前外侧小切口和传统正中开胸二尖瓣手术的临床结果.[方法]2009年10月至2011年5月,行微创二尖瓣手术46例(小切口组),选择同期传统正中开胸二尖瓣手术45例(正中切口组).比较两组手术情况、患者术后情况及围术期心功能变化.[结果]两组患者均无院内死亡、低心排综合征、呼吸系统及中枢神经系统并发症.小切...     

右前外侧小切口微创心脏手术的临床研究

目的探讨右前外侧小切口微创心脏手术的临床疗效。方法选取二尖瓣病变或房间隔缺损患者43例,将其分成小切口组21例和正中切口组22例。比较两组患者疼痛度、输血量、术后引流量、建立体外循环时间、阻断时间、ICU监护时间及转流时间。结果小切口组建立体外循环时间、转流时间及阻断时间均与正中切口组无显著差异,而切口长度、引流量、输血量、术后呼吸机通气时间、ICU监护时间、住院时间、曲马多使用次数均较正中切口组减少,差异具有显著性。小切口组出现右肺局限性肺不张2例。因主动脉根部插管部位出血延长切口止血1例,起搏导线失效1例,二次开胸止血1例。结论右胸前外侧小切口行微创心脏手术安全有效,美容效果好,但需注意防止并发症的发生。     

右胸前外侧小切口不停心跳直视手术在ASD修补术中的应用

目的 探讨右胸前外侧小切口不停心跳直视手术在房间隔缺损(ASD)修补术中的临床意义.方法 对170例ASD串者采用右胸前外侧小切口不停心跳心内直视手术的资料进行回顾性分析.结果 170例手术均顺利,无死亡病例,术后血流动力学稳定,170例患者均痊愈出院;术后随访心功能恢复良好,切口瘢痕小.结论 右胸前外侧小切口心内直视术式治疗ASD,临床应用安全、疗效满意,可作为治疗ASD一种常规术式使用.     

Minimally invasive heart valve surgery: already established in clinical routine?

Cardiac valve replacement with the need for open heart surgery still has the highest morbidity and mortality rates among routine cardiac surgery, with the exception of aortic aneurysm repair and surgery for congenital heart defects. Reducing invasiveness is a desirable goal, and different strategies and approaches have been used to achieve this with valve repair or replacement less invasive. Despite the good results reported with minimally invasive techniques, time on extracorporal circulation is always longer compared with the conventional procedures. Since these techniques do not reduce real invasiveness but rather improve the cosmetic results, minimal-access surgery would be a better nomenclature. With the exception of patients at a high risk for sternal infections or redo heart operations, a reduction in postoperative morbidity by the avoidance of a median sternotomy is not yet definitely proven. Meanwhile, most surgeons comply with the demand for minimally invasive surgery posed by patients by reducing the length of the incision in aortic valve replacement and by using a right anterolateral approach with a limited incision for mitral valve operations. However, the use of endoscopic or robotic devices is limited to a few centers, and has not yet found its way into clinical routine. Nonetheless, minimally invasive or minimal-access surgery is now established in many centers, and patients should always be informed of these techniques. When this information is provided objectively and patient selection is carried out accurately, these alternative approaches can help to improve postoperative convalescence.     

Minimally invasive heart valve surgery: already established in clinical routine?

Cardiac valve replacement with the need for open heart surgery still has the highest morbidity and mortality rates among routine cardiac surgery, with the exception of aortic aneurysm repair and surgery for congenital heart defects. Reducing invasiveness is a desirable goal, and different strategies and approaches have been used to achieve this with valve repair or replacement less invasive. Despite the good results reported with minimally invasive techniques, time on extracorporal circulation is always longer compared with the conventional procedures. Since these techniques do not reduce real invasiveness but rather improve the cosmetic results, minimal-access surgery would be a better nomenclature. With the exception of patients at a high risk for sternal infections or redo heart operations, a reduction in postoperative morbidity by the avoidance of a median sternotomy is not yet definitely proven. Meanwhile, most surgeons comply with the demand for minimally invasive surgery posed by patients by reducing the length of the incision in aortic valve replacement and by using a right anterolateral approach with a limited incision for mitral valve operations. However, the use of endoscopic or robotic devices is limited to a few centers, and has not yet found its way into clinical routine. Nonetheless, minimally invasive or minimal-access surgery is now established in many centers, and patients should always be informed of these techniques. When this information is provided objectively and patient selection is carried out accurately, these alternative approaches can help to improve postoperative convalescence.     

An alternative, less invasive approach to median sternotomy for cardiac operations in adults: right infra-axillary minithoracotomy

We compared the use of right infra-axillary minithoracotomy and conventional median sternotomy in direct open-heart surgery in 59 adults undergoing elective surgery for mitral valve stenosis, mitral valve disease, atrial septal defect repair, left atrial myxoma excision or mitral and tricuspid valve disease. Patients were randomized to the infra-axillary minithoracotomy group (Group A; n = 29) or the median sternotomy group (Group B; n = 30). Post-operative outcomes (post-operative bleeding; cross-clamp time; length of hospital and intensive care unit stays; and post-operative blood transfusion and analgesic requirements) were recorded and compared; they were found to be significantly lower in Group A than Group B. We concluded that right infra-axillary minithoracotomy is less invasive and can be used safely in adults as an alternative approach to conventional median sternotomy for some cardiac operations. Further multicentre studies in adults are now needed.     

微创心脏手术中的心肌保护措施及效果

目的:探讨微创心脏手术中的心肌保护措施及效果。方法:选取63例行微创心脏手术的患者,作为微创组,另选同期63例经胸骨正中切口行心脏手术的患者作为对照组。微创组采用冷血停跳液顺行灌注加逆行灌注,辅以相应的心肌保护措施。术后观察并比较两组患者的心脏自动复跳率、心电图ST段异常发生率、左室射血分数(left ventricular ejection fraction,LVEF)以及心力衰竭发生率等。结果:微创组术后心脏自动复跳率、心电图ST段异常发生率、LVEF以及心力衰竭发生率与对照组的差异均无统计学意义(P0.05)。结论:采取适当的心肌保护措施可使微创心脏手术中心肌损伤的风险降低至与胸骨正中切口心脏手术接近。     

Minimally invasive valve surgery: different techniques and approaches

Less invasive approaches to cardiac surgical procedures are being developed in an effort to decrease patient morbidity and enhance postoperative recovery in comparison with conventional methods. Although full median sternotomy has been the standard surgical approach to the heart for more than 30 years, minimally invasive techniques using limited incisions are rapidly gaining acceptance. Potential advantages of a small skin incision include less trauma and tissue injury, leading to a less painful and quicker overall recovery, as well as shorter hospital stays for patients. Decreasing the size of the skin incision for minimally invasive valve surgery to significantly less than the cardiac size requires specific access to the valve to be repaired or replaced. Thus, various minimally invasive techniques and approaches have been described for aortic and mitral valve surgery [111]. This article will review the different minimally invasive techniques and approaches, as well as early results and outcomes for aortic and mitral valve surgery.     

Minimally invasive repair of the mitral valve: Technological and clinical developments

Abstract

The present article will review new technology in the invasive approach to mitral valvular disease. Mitral valve pathology continues to present an important challenge to the cardiac surgeon and interventionalist. From the early days of closed mitral valvular commisurotomy, a number of new approaches to this valve have been developed. Mitral stenosis was previously approached through a minimally invasive beating heart surgical approach, but may now be treated with either catheter-based or open surgical techniques. Regurgitation, which has become the leading pathology of the mitral valve in the developed world, may be approached through traditional cardiac surgery or through catheter-based techniques. New imaging techniques and device innovation will cause drastic changes in therapy for mitral valvular disease in the foreseeable future.