全胸腔镜下房间隔缺损修补术

South China Journal of Cardiovascular Diseases,July 2018,Vol 24,No 4全胸腔镜下房间隔缺损修补术△

朱任，黄焕雷

［广东省心血管病研究所广东省华南结构性心脏病重点实验室广东省人民医院（广东省医学科学院），广州510100］

摘要：目的分析单一术者连续完成的50例全胸腔镜下房间隔缺损修补术的早期结果，总结经验并分析学习

曲线。方法2013年1月至2015年12月，由广东省人民医院单一术者连续完成全胸腔镜下房间隔缺损修补

术患者50例。以手术时间为序分为两组：前25例为A 组，后25例为B 组，比较两组在体外循环时间、主动脉

阻断时间、术后24h 胸液量、机械通气时间等指标的差异。手术采用股动静脉插管及颈静脉插管建立外周体

外循环，心内操作在全胸腔镜下完成。结果两组中仅1例患者输注血浆200mL ，无输注红细胞的患者，未

输血率达98%（49/50）。无患者手术死亡，未出现围术期并发症。所有患者在出院前均复查超声心动图，未发

现残余分流。B 组的体外循环时间、术后24h 胸液量、机械通气时间，重症监护病房入住时间等指标均低于A

组；其中B 组主动脉阻断时间及术后住院时间显著低于A 组，差异有统计学意义（P <0.05）。结论全胸腔镜

下房间隔缺损修补术安全有效，具有创伤小、出血少、术后康复快等优点。经一定的学习曲线后，微创手术操

作技术及质量趋于稳定

关键词：房间隔缺损；全胸腔镜；外科治疗

中图分类号：R541.7文献标志码：A 文章编号：1007-9688（2018）04-0420-03

Atrial septal defect repair

through completed video-assisted thoractomy ZHU Ren ，HUANG Huan-lei （Guangdong Provincial Key Laboratory of South

China Structural Heart Disease ，Guangdong Cardiovascular Insti⁃tute ，Guangdong General Hospital ，Guangdong Academy of Medical Sciences ，Guangzhou 510100，China ）Abstract ：Objectives To summarize the experience of atrial septal defect （ASD ）repair through completed video-assisted thoractomy by a single surgeon in 50patients ，and analysis of the learning curve.Methods Between January

2013and December 2015，50patients with ASD in Guangdong General Hospital were treated by completed video-

assisted surgery through right anterolateral thoraetomy incision.According to the order of operating time ，the patients were divided into two groups ：the former 25cases in A group ，the later 25cases in B group.Cardiopulmonary bypass （CPB ）duration ，aortic occlusion （ACC ）duration ，chest fluid volume at 24h after operation ，duration of mechanical ventilation and other indicators were

compared between the two groups.Femoral arteriovenous and jugular vein

intubation were adopted to establish the peripheral extracorporeal circulation.Intracardiac operation was through completed video-assisted

thoractomy.Results

The no

blood transfusion rate

was 98%

（49/50）.There was no operative death or intraoperative complications.All patients′echocardiography appeared no residual shunt before hospital

discharge.CPB duration ，chest fluid volume at 24h after operation ，duration of mechanical ventilation ，duration

of

intensive care unit and other indicators of Group B were lower than those of A group ；among the above indicators ，ACC duration and duration of postoperative hospitalization in B group were obviously lower than those in A group （P <0.05）.Conclusions Completed video-assisted thoractomy is proven to be safe and effective for closure of ASD ，with small trauma ，less bleeding and fast postoperative recovery.After a short learning curve ，the technology and quality of mini⁃mally invasive surgery operation would be stable.Key words ：atrial septal defect ；completed video-assisted thoracoscopy ；surgery intervention

doi ：10.3969/j.issn.1007-9688.2018.04.13·论著·△基金项目：广东省科技计划项目（项目编号：2014A020209050）

作者简介：朱任（1991-），男，住院医师研究方向为心脏瓣膜病。通信作者：黄焕雷,E-mail:hhuanlei@

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