胸腔镜辅助微创手术治疗先天性心脏病的临床体会

摘要： 目的 回顾总结胸腔镜辅助微创手术治疗先天性心脏病的临床疗效及手术经验体会。方法 154例行胸腔镜下微创手术治疗的先天性心脏病患者， 成人组112例， 未成人组42例。手术经右胸肋间切口， 胸腔镜辅助暴露视野， 上腔静脉及股动静脉插管建立体外循环， 手术原则与开胸手术相同。监测2组患者手术时间、 体外循环时间、升主动脉阻断时间、 术后重症监护病房 （ICU） 监护时间、 住院时间、 术后引流量及并发症情况。结果 154例患者均治愈出院， 2组患者手术时间、 体外循环时间、 主动脉阻断时间、 ICU时间、 住院时间差异均无统计学意义， 成人组术后引流量多于未成人组 （P＜0.05）。成人组发生并发症4例 （3.6%）， 术中转正中开胸手术1例， 二次手术止血1例， 术后气胸1例， 迟发性胸腔积液1例； 未成人组发生并发症2例 （4.8%）， 其中股动脉内膜撕脱， 行股动脉人工血管搭桥手术 1例， 迟发性胸腔积液1例。2组并发症发生率差异无统计学意义 （P＞0.05）。2组均未发生严重并发症及死亡。结论 胸腔镜下微创手术治疗先天性心脏病对成年人和未成年人都是安全可靠的， 具有创伤小， 出血少， 严重并发症少， 术后恢复快等优点。但医生需要一定学习曲线， 需严格掌握手术适应证。

Clinical experience of thoracoscopic assisted minimally invasive surgery for congenital heart disease

Abstract: Objective To summarize the clinical experience and the clinical therapeutic effect of minimally invasive surgery for congenital heart disease under thoracoscope. Methods A total of 154 patients of congenital heart disease treated by minimally invasive surgery through thoracoscopic surgery were divided into two groups, adult group (n=112) and minor group (n=42). Through the right chest intercostal incision, thoracoscopic assisted exposure of the surgical field of visual, superior vena cava and femoral vein catheterization, cardiopulmonary bypass were established. The principle of operation was the same as that of thoracotomy. Data of operation time, extraeorporeal circulation time, cross-clamping time, ICU time, length of hospital stay, amount of drainage and the complications were observed in two groups of patients. Results Operations were successful and all patients recovered well. There were no significant differences in operation time, extraeorporeal circulation time, cross-clamping time, ICU time and length of hospital stay between two groups of patients. In adult group, the amount of drainage was significantly increased than that in minor group (P＜0.05). In adult group, there were 4 cases with complications (3.6%), 1 case was changed to median thoracotomy surgery, 1 case was undergone reoperation for bleeding, 1 case had delayed pleural effusion, and 1 case had pneumothorax. In minor group, there were 2 cases with complications (4.8%), 1 case had injury of femoral artery and had bypass operation immediately and 1 case had delayed pleural effusion. There was no significant difference in complications between 2 groups (P＞0.05). There was neither serious complication nor death in both adult and minor groups. Conclusion Minimally invasive thoracoscopic surgery for congenital heart disease is safe and reliable for both adults and minors. It has the advantages of small trauma, less bleeding, less serious complications and quick recovery after operation. However, it takes surgeons some time to grasp the operative skill skillfully, and the operative indication should be controlled strictly.