全胸腔镜下成人房间隔缺损修补手术20例临床分析

发布时间：2018-05-21 13:41

  本文选题：全胸腔镜 + 房缺　； 参考：《中国内镜杂志》2017年02期

【摘要】：目的回顾性分析全胸腔镜下行20例成人房间隔缺损修补手术的临床效果,总结全胸腔镜下心脏手术经验。方法该院自2014年3月-2016年8月,采用右侧股动脉、股静脉插管建立周围体外循环,主动脉根部顺行灌注冷血停跳液保护心肌,在右侧胸壁打3孔完成成人房间隔缺损修补心脏手术20例,分析手术时间、主动脉阻断时间、体外循环时间、呼吸机辅助时间、胸腔引流情况、住院天数和并发症等临床资料。结果全组患者手术时间为3.5~5.0 h,平均(3.8±0.5)h;升主动脉阻断时间为28~46 min,平均(29.8±8.2)min;体外循环时间为86~108 min,平均(80.6±11.5)min;呼吸机辅助时间5~8 h,平均(6.0±0.8)h;胸腔引流量100~260 ml,平均(150.0±35.0)ml;术后住院时间6~9 d,平均(6.5±1.2)d。全组患者无手术死亡,术后无残余分流发生,有1例患者腹股沟伤口脂肪液化,予以加强伤口换药处理;1例患者胸腔积气,予以穿刺后好转;1例患者因右侧胸腔粘连改为胸腔镜辅助,患者恢复顺利,全组无严重并发症发生。术后3~5天超声心动图示手术效果满意,患者顺利出院。随访1~28个月,无残余分流,无下肢静脉血栓形成,心功能均为Ⅰ级。结论全胸腔镜下成人房间隔缺损修补心脏手术安全可行,手术创伤小,切口美观,术后引流少,患者恢复快。
[Abstract]:Objective to retrospectively analyze the clinical results of 20 adult patients with atrial septal defect (ASD) under total thoracoscopy and summarize the experience of total thoracoscopic cardiac surgery. Methods from March 2014 to August 2016, the right femoral artery was used to establish peripheral cardiopulmonary bypass (CPB), and the aortic root was perfused with cold blood cardioplegia to protect myocardium. Twenty cases of adult atrial septal defect repair were performed with 3 holes in the right chest wall. The clinical data such as operation time, aortic occlusion time, cardiopulmonary bypass time, ventilator assisted time, thoracic drainage, hospital stay and complications were analyzed. Results the operative time was 3.5 卤5.0 h (mean 3.8 卤0.5 min), ascending aorta occlusion time was 284min (29.8 卤8.2 min), cardiopulmonary bypass (CPB) time was 86 ~ 108 min (mean 80.6 卤11.5 min), ventilator assisted time was 5 ~ 8 h (mean 6.0 卤0.8 h), thoracic drainage volume was 100 ~ 260ml (mean 150.0 卤35.0ml), postoperative hospitalization time was 69th day (6.5 卤1.2d). There was no operative death, no residual shunt occurred in all patients, and one patient with fat liquefaction in the inguinal wound was treated with enhanced wound dressing. After puncture, 1 case of right thoracoscopic adhesion was replaced by thoracoscopy, the patient recovered smoothly and no serious complications occurred in the whole group. Echocardiography showed satisfactory results on 3 ~ 5 days after operation, and the patient was discharged smoothly. Follow-up for 1 ~ 28 months showed no residual shunt, no venous thrombosis in lower extremities, and cardiac function was grade 鈪，

本文编号：1919424