摘要
目的总结直视微创心脏外科手术临床应用的初步效果和优点。方法2010年4月至2011年8月，完成直视微创心脏外科手术108例，其中男44例，女64例；平均年龄（44．3±16．4）岁；平均体重（60．0±12．0）kg。二尖瓣置换（MVR）29例，主动脉瓣置换（AVR）17例，二尖瓣成形术（MVP）5例，MVR＋AVR6例，室间隔缺损修补术（VSD）12例，房间隔缺损修补术（ASD）23例，不停跳直视微创冠状动脉旁路移植术（MIDCAB）9例，MVR＋CABG术1例，部分型心内膜垫缺损矫治术（PECD）2例，Ebstein畸形矫治术1例，三尖瓣隔叶腱索断裂修复术1例。同期手术包括三尖瓣成形术（TVP）19例，射频消融术11例。除MIDCAB术外，其余手术均在闭式体外循环下完成。2例中转常规开胸完成。结果体外循环36—260min，平均（104．4±59．3）min；主动脉阻断0～204．0min，平均（66．7±52．8）min。心脏停跳下实施手术80例，术后自动复跳74例；气管插管2．0—90．0h，平均（14．5±11．9）h；ICU停留4．0—138．0h，平均（18．8±15．3）h；术后住院3．0～24．0天。平均（6．9±2．9）天；切口长度3．5～10．0am，平均（5．3±1．2）am；术后第1天引流量（337．6±240．9）ml；未输血者72例，围手术期及出院后近期无死亡，无二次开胸止血和胸骨切口感染者。出院时心功能I级94例、Ⅱ级8例、Ⅲ级6例。结论直视微创心脏外科手术的近期效果良好，手术安全性高，适用范围广；具有创伤小，出血和输血少，切口美观，无胸骨感染，并发症和病死率少等优点。
Objective The aim of this study is to summarize primarily the application range and the clinical effect of the minimally invasive direct cardiac surgery （MIDCS）. Methods From April 2010 to August 2011, 108 operations had been performed in our centre using MIDCS, among of which 44 males and 64 females, mean age （44.3 ± 16.4） years old, mean weight（60.0 ± 12.0） kg. These operations included 29 MVR operations （replacement with mechanical valve 19, with tissue valve 10）, 17 AVR operations （replacement with mechanical valve 11, with tissue valve 6 ） ,5 MVP operations,6 MVR ＋ AVR operations （ replacement with mechanical valve 5, with tissue valve 1 ） , 12 VSD repair operations and 23 ASD repair operations, 9 MIDCAB operations, 1 MVR ＋ CABG oparation,2 PECD correction , l repair of ruptruee ehordae tendineae of tricuspid sep- rum and 1 Ebstein deformity correction operation. Concomitant procedures included 19 TVP operations and 11 radiofrequency ablation operations. Except MIDCAB operations, other operations are performed with closed type extraeorporeal circulation. Conversion to median sternotomy was necessary in only two patients （ 1.9% ）. Results Mean cardiopulmonary bypass time and aortic cross-clamp time were （ 104.4 ± 59.3 ） minutes and （ 66.7 ± 52.8 ） minutes respectively, 74 patients （92.5 % ） recover to beat automatically after heart ceased operation. Median mechanical ventilation time was （ 14.5 ± 11.9 ） hours, Median intensive care unit stay was （18.8 ± 15.3 ）hours , median hospital stay post operative was （6.9 ± 2.9）days. Median incision length was （5.3 ± 1.2 ）cm. Median draining volume was （337.6 ±240.9 ）ml in the first day after operation, No transfusion occurred in 72 patients（66.7% ）. Hospital mortality was 0. No re-exploration for bleeding and sternal wound infection. When leaving hospital,94 being of heart functional class Ⅰ ,8 of class Ⅱ,6 of class Ⅲ. Conclusion MIDCS was associated with good operative effect in the nea
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2012年第5期289-293,共5页
Chinese Journal of Thoracic and Cardiovascular Surgery
关键词
心脏外科手术
外科手术
微创性
可行性研究
治疗结果
Cardiac surgical procedures Surgical procedures, minimally invasive Feasibility studies Treatment outcome
