CAJ | 학술논문

目的总结全胸腔镜下心房黏液瘤手术的经验.方法 2007年12月至2011年11月,全胸腔镜下心房黏液瘤手术44例,其中左心房黏液瘤35例,右心房黏液瘤6例,双心房黏液瘤3例.通过右侧胸壁3孔建立体外循环,股动脉、静脉插管(或右心房、股静脉分别插上、下腔静脉插管),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( 49±18) min,升主动脉阻断(28±10) min,术后呼吸机辅助(3.8±1.4)h,术后住院(6.8±1.3)天.术后并发症3例,1例为腹股沟切口液化,伤口延期愈合；2例皮下气肿,胸带加压包扎治愈.无严重并发症发生.全组术后3～5天超声心动图示手术效果满意.术后失访20例,余24例随访2个月至4年,心功能均Ⅰ级.结论全胸腔镜下心房黏液瘤手术安全可靠,创伤小,患者恢复快.
목적 총결전흉강경하심방점액류수술적경험.방법 2007년12월지2011년11월,전흉강경하심방점액류수술44례,기중좌심방점액류35례,우심방점액류6례,쌍심방점액류3례.통과우측흉벽3공건입체외순배,고동맥、정맥삽관(혹우심방、고정맥분별삽상、하강정맥삽관),조단겸조단승주동맥,랭정체(함혈)심장정박액순행관주보호심기.결과 수술균획성공,체외순배( 49±18) min,승주동맥조단(28±10) min,술후호흡궤보조(3.8±1.4)h,술후주원(6.8±1.3)천.술후병발증3례,1례위복고구절구액화,상구연기유합；2례피하기종,흉대가압포찰치유.무엄중병발증발생.전조술후3～5천초성심동도시수술효과만의.술후실방20례,여24례수방2개월지4년,심공능균Ⅰ급.결론 전흉강경하심방점액류수술안전가고,창상소,환자회복쾌.
Objective To Summarize the experience of totally thoracoscopic operation for atrial myxoma.Methods From December 2007 to November 2011,44 patients with atrial myxoma,including 37 cases of Left atrial myxoma,6 cases of Right atrial myxoma,1 case of double atrial myxoma 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circulation and cross-clamping time were (49 ± 18 )min and (28 ± 10) min respectively.Postoperative ventilation was withdrawn in(3.8 ± 1.4) h,and the patients were discharged from the hospital in (6.8 ± 1.3 ) d.3 of the patients had postoperative complications,including 1 case of fat liquefaction of the incision at the right groin ( delayed healing),2 cases of subcutaneous emphysema ( healed by bandaged chest).No severe complications occurred in this series.UCG performed 3 - 5 days after the operation revealed surgical results were satisfactory.Followup up to 2 months to 4 years were available in all cases.During the period,the heart function was confirmed as level Ⅰ.Conclusion Video-assisted thoraeoseopie cardiac surgery is feasible,safe,and minimal invasive for patients,resulting in quick recovery and good cosmetic outcomes.