胸腔镜辅助下心脏手术体外循环的建立与管理(附30例报告)

目的 总结胸腔镜下心脏手术的体外循环建立方法和体外循环的管理。方法 分析30例心脏病患者借助于电视胸腔镜进行房间隔缺损修补，室间隔缺损修补，二尖瓣置换，Ebstein畸形矫治，部分房室管畸形的体外循环过程和术后结果。结果 1例患者停体外循环后因血氧饱和度偏低，延长第4肋间切口探查；1例因手术操作导致出血而延长切口再次插管建立体外循环；1例患者因残余漏再次手术，其余27例患者手术过程顺利。30例患者术后均恢复良好。结论 胸壁打孔体外循环下完全借助于电视胸腔镜实施心脏手术安全、可行；开展此手术的初期体外循环时间和主动脉阻闭时间相对较长，应加强体外循环的管理。

Application of cardiopulmonary bypass with totally video-assisted thoracoscopy in heart operation Reports of 30 cases

Objective To summarize the way and management of cardiopulmonary bypass (CPB) with totally video-a ssisted thoracoscopy in heart operation.Methods The process and postoperative results of 30 patients undergoing operation of CPB with totally video-assisted thoracoscopy were analyzed.The patients involved were 12 cases of atria septal defect, 15 ventricular septal defect,1 mitral valve stenosis, 1 Ebstein deformed and 1 partia atrioventricular canal defect. Results Of the 30 cases, 1 case was reoperated because of there sidual shuntos of ventricular septal defect. The incison of another 2 case were extende during operation because of low saturation of peripheral arteries and aorta wall bleeding.The rest 27 cases were successfully operated by applying cardiopulmonary bypass with totally video-assisted thoracoscopy. All patients recovered well postoperatively and discharged uneventfully.Conclusion Heart operations can be done by applying cardiopulmonary bypass with totally video-assisted thoracoscopy. The method is safe and practicable. But it should be modified to shorten the duration of CPB and aorta clamping.