全胸腔镜下房间隔缺损修补手术单中心临床研究

目的总结全胸腔镜下房间隔缺损修补手术临床经验。方法2008年5月至2018年12月442例房间隔缺损患者在我院行全胸腔镜下心脏手术,其中男149例、女293例,年龄3~74(29.1±14.3)岁。采用右侧胸壁3孔入路,在全胸腔镜下完成心脏手术。结果本组442例患者均治愈出院,无中转正中开胸,全组患者手术时间1.5~4.6(2.2±0.3)h,体外循环时间28~118(55.9±13.3)min,升主动脉阻断时间8~78(21.5±10.2)min,术后呼吸机辅助时间3.5~122.0(8.1±7.4)h,术后住重症监护室时间13~141(20.7±10.2)h,术后胸腔引流量70~1280(251.8±131.5)mL,术后住院时间4~16(7.1±1.4)d。全组有15例(3.3%)患者出现并发症。术后随访1~128(67.6±33.3)个月,出现持续性心房颤动25例,轻中度三尖瓣关闭不全25例,中度三尖瓣关闭不全1例,无再次手术及残余分流发生,心功能明显好转。结论完全胸腔镜下房间隔缺损修补手术安全可行,手术创伤小、并发症少,具有较好的近中期疗效。

Totally thoracoscopic repair of atrial septal defect:A single-center clinical study

Objective To summarize the experience of totally thoracoscopic cardiac surgery(TTCS)for atrial septal defect.Methods Clinical data of 442 patients undergoing TTCS for atrial septal defect from May 2008 to December 2018 in Shanghai Yodak Cardiothoracic Hospital was analyzed retrospectively.There were 149 male and 293 female patients,aged 3-74(29.1±14.3)years.Surgical procedures were performed through 3 ports at the right chest wall.Results All the operations were completed successfully.Mean operative time was 1.5-4.6(2.2±0.3)h.The mean extracorporeal circulation and aortic cross-clamp time was 28-118(55.9±13.3)min and 8-78(21.5±10.2)min,respectively.Mechanical ventilation and intensive care unit stay time was 3.5-122.0(8.1±7.4)h and 13-141(20.7±10.2)h,respectively.Postoperation drainage volume was 70-1280(251.8±131.5)mL.The hospital stay was 4-16(7.1±1.4)d.Intraoperative and postoperative complications occurred in 15 patients(3.3%).The mean follow-up time was 1-128(67.6±33.3)months,and during the period,there were 25 patients of atrial fibrillation,25 patients of mild-moderate tricuspid valve incompetence,1 patient of moderate tricuspid valve incompetence.There was no reoperation or residual shunt during the period of follow-up.And the heart function was improved.Conclusion TTCS is a feasible,safe and minimal invasive approach for patients with atrial septal defect and has good short to medium-term outcomes.