CAJ | 학술논문

目的总结全胸腔镜下先天性心脏病手术的经验.方法 2000年9月至2011年11月,全腔腔镜下先天性心脏病手术1281例,其中房间隔缺损1016例,室间隔缺损110例,房室管畸形61例,法洛三联症33例,部分肺静脉异位引流24例,肺动脉瓣狭窄12例,动脉导管未闭9例,三房心8例,无顶冠状静脉窦综合征7例,完全肺静脉异位引流1例.术时右侧胸壁3孔,股动脉、静脉插管(或右房、股静脉分别插上、下腔静脉插管)建立体外循环,阻断钳阻断升主动脉,冷晶体(含血)心脏停搏液顺行灌注保护心肌.结果手术均获成功,体外循环(42±16) min,升主动脉阻断(21 ±9)min,术后呼吸机辅助(4.1±1.5)h,术后住院(7.1±1.4)天.术后35例发生并发症,右侧气胸16例,胸腔穿刺1次治愈；皮下气肿12例,胸带加压包扎治愈；右腋下切口液化3例、腹股沟切口液化4例,伤口延期愈合.全组术后4～8天超声心动图示畸形矫治满意.914例术后随访3个月～9年,心功能Ⅰ～Ⅱ级.结论全腔镜下先天性心脏病手术安全可靠,创伤小,患儿(者)恢复快.
목적 총결전흉강경하선천성심장병수술적경험.방법 2000년9월지2011년11월,전강강경하선천성심장병수술1281례,기중방간격결손1016례,실간격결손110례,방실관기형61례,법락삼련증33례,부분폐정맥이위인류24례,폐동맥판협착12례,동맥도관미폐9례,삼방심8례,무정관상정맥두종합정7례,완전폐정맥이위인류1례.술시우측흉벽3공,고동맥、정맥삽관(혹우방、고정맥분별삽상、하강정맥삽관)건입체외순배,조단겸조단승주동맥,랭정체(함혈)심장정박액순행관주보호심기.결과 수술균획성공,체외순배(42±16) min,승주동맥조단(21 ±9)min,술후호흡궤보조(4.1±1.5)h,술후주원(7.1±1.4)천.술후35례발생병발증,우측기흉16례,흉강천자1차치유；피하기종12례,흉대가압포찰치유；우액하절구액화3례、복고구절구액화4례,상구연기유합.전조술후4～8천초성심동도시기형교치만의.914례술후수방3개월～9년,심공능Ⅰ～Ⅱ급.결론 전강경하선천성심장병수술안전가고,창상소,환인(자)회복쾌.
Objective To summarize the experience of totally thoracoscopic operation for congenital heart diseases.Methods From September 2000 to November 2011,1281 patients with congenital heart disease,including 1016 cases of atrial septal defect,110 cases of ventricular septal defect,61 cases of atrioventricular tube defects,33 cases of tetralogy of Fallot,24 cases of part anomalous pulmonary venous connection,12 cases of pulmonary valve stenosis,9 cases of patent ductus arteriosus,8 case of triatriatum,7 cases of unroofed coronary sinus syndrome,and 1 case of total anomalous pulmonary venous connection were treated totally under thoracoscope.Surgical procedures were performed through 3 troears inserted at the right chest wall,and catheters were placed in the right femoral artery and vein ( or in the right atrium,femoral vein) to set up extracorporeal circulation.The ascending aorta was cross-clamped with long tailor-made forceps and the myocardium was protected by coronary perfusion with cold crystalloid (blood) cardioplegia.Results All the operations were completed successfully.The mean extracorporeal circulation and cross-clamping time were ( 42 ± 16 ) min and ( 21 ± 9 ) min respectively.Postoperative ventilation was withdrawn in(4.1 ± 1.5 ) h,and the patients were discharged from the hospital in(7.1 ± 1.4) d.35 of the patients had postoperative complications,including 16 cases of right pneumothorax (healed by thoracentesis),12 cases of subcutaneous emphysema ( healed by bandaged chest) and 7 cases of fat liquefaction of the incision at the right axillary( 3 cases) and groin(4 cases) ( delayed healing).No severe complications occurred in this series.UCG performed 4 - 8 days after the operation revealed no residual shunt.Follow-up up to 3 months to 9 years were available in 914 cases.During the period,the heart function was confirmed as level Ⅰ - Ⅱ.Conclusion Totally thoracoscopic cardiac surgery is feasible,safe,and minimal invasive for patients,resulting in quick recovery and good cosmetic outcomes.