微创心脏手术56例临床研究

目的：总结分析右胸前外侧微创小切口行心脏手术的临床经验，探讨其临床意义。方法：对我科2012年1月-2013年3月期间56例实施了直视微创心脏手术患者资料进行分析。其手术径路为经右胸前外侧第4肋间切口，采用股动脉、股静脉建立体外循环，经右房切口实施房室缺修补术、经房间沟或右房切口实施瓣膜置换手术，术后评估手术效果。并与行常规正中开胸心脏手术25例患者进行比较。结果：微创手术组有5例患者因体形肥胖术野暴露困难而延长手术切口；3例有右侧胸腔黏连，予游离胸膜腔后继续心脏手术；其余患者手术过程较顺利，均获成功，无死亡患者。其平均手术时间为（183.5＆#177;65.2） min，平均体外循环时间为（59.2＆#177;21.5） min，心脏停跳患者平均升主动脉阻断时间（44.3＆#177;24.6） min，术后呼吸机辅助平均机械通气时间（7.0＆#177;3.1） h，术后24 h平均胸腔积液引流量（289.4＆#177;117.2） mL，平均住院时间（10.5＆#177;4.2） d，未见严重手术并发症发生。微创手术组和常规手术组两组间患者体外循环时间、主动脉阻断时间和呼吸机辅助呼吸时间以及住院总费用方面差异无统计学意义，微创手术组较常规手术组总手术时间略长但术后胸管引流量明显减少、住院时间明显缩短。结论：右胸前外侧小切口直视下可完成微创径路房室缺修补和二尖瓣瓣膜置换术，对患者生理及心理创伤小，安全易行。与传统手术相比，微创手术患者术后康复期短，切口美观，在适用范围内值得临床广泛推广和应用。

Minimally invasive cardiac surgery in 56 patients

Objective： To review and summarize the experience of minimally invasive cardiac surgery（MICS） in 56 patients via right minithoracotomy. Methods： From January 2012 to March 2013, 56 patients with cardiac disease, including arterial septal defect（ASD）, ventricular septal defect（VSD）, mitral insufficiency（MI） and mitral stenosis（MS）, were enrolled and underwent MICS. Surgical access was through a right anterolateral thoracotomy in the forth intercostal space. A main surgical wound was made over the lateral border of the right breast. Cardiopulmonary bypass was established via femoral cannulation. The procedures of mitral valve replacement were performed via interatrial groove or right atrium , while both ASD and VSD via right atrium. 25 patients with cardiac disease, including ASD, VSD, Mitral Insufficiency（MI） and MS, were also enrolled and underwent cardiac surgery procedures. Surgical accesses of these patients were through median sternotomy for operation. Results：All the operations were successful and all the patients were cured and discharged in the minimally invasive operation group. Mean operation, cardiopulmonary bypass and aortic clamp times were （183.5＆#177;65.2） min, （59.2＆#177;21.5） min and （44.3＆#177; 24.6） min respectively. The mean postoperative ventilation time was （7.0＆#177;3.1） h. The mean total chest tube drainage in the first day post-operation was （289.4＆#177;117.2） mL, and mean length of hospital stay were （10.5＆#177;4.2） d. Cardiopulmonary bypass time, aortic clamping time, ventilation time and total cost of hospitalization were not statistically significant between minimally invasive operation group and routine operation group. Total operation time was slightly longer in minimally invasive operation group than conventional operation group, but postoperative chest tube drainage volume significantly reduced, and hospitalization time was shortened obviously. Conclusion： MICS through a right anterolateral thoracotomy but without thoracoscopic-assisted is safe and feasible. It makes good cosmetic results and rapid postoperative recovery , and shortens length of hospital stay. MICS is worthy of widely clinical elective application.