中国现代医学杂志2018，Vol.28Issue(11)：60-64,5.DOI:10.3969/j.issn.1005-8982.2018.011.011
全胸腔镜心脏手术在老年患者中的临床应用
Clinical application of totally video-assisted cardiac surgery to patients with heart disease over 60 years
摘要
Abstract
Objective To summarize the clinical experience of totally video-assisted cardiac surgery for the patients with heart disease over 60 years, and evaluate its safety and efficacy. Methods From December 2014 to July 2016, 14 patients including 6 males and 8 femals underwent totally video-assisted cardiac surgery in Cardiac Surgery Center of Sichuan Provincial People's Hospital. Their mean age was (64.50 ± 4.62) years. All patients were ventilated with a double lumen endotracheal tube after general anesthesia. Superior vena cava, right femoral artery and vein cannulation were used to establish cardiopulmonary bypass (CPB). Three holes were poked respectively in the 3rd, 4th and 5th intercostal space at right chest wall. Intracardial procedures such as atrial septal defect repair, left atrial myxoma excision, tricuspid valve repair, mitral valve repair or replacement, unipolar radiofrequency ablation, direct suture of left atrial appendage inlet orifice were completed through totally video-assisted approach. Results No patient was converted to anterior median thoracotomy. No death was found. All patients were cured and discharged from hospital. The mean CPB time, aortic occlusion time, operation time, postoperative ventilator support time,postoperative intensive care unit stay time and postoperative hospitalization time were (130.71 ± 34.32) min, (69.14 ± 36.08) min, (252.50 ± 80.14) min, (8.93 ± 5.40) h, (24.93 ± 16.08) h, and (9.93 ± 3.03) d respectively. The mean intraoperative blood loss was (160.71 ± 84.10) ml. The thoracic drainage volume in 24 h after operation was (108.57 ± 55.59) ml. The thoracic drainage time was (2.65 ± 1.47) d. The mean blood transfusion volume was (375.00 ± 183.71) ml. No obvious abnormalities were found by ultrasound echocardiography before discharge. The patients were followed up for (10.21 ± 7.63) mon. During the follow-up period, no patient died. The heart function was improved to grade I or II which was better than that before operation (P < 0.05), left atrial dimension and left ventricular end diastolic dimension were also significantly reduced (P < 0.05). Conclusions In the patients over 60 years with heart disease, totally video-assisted cardiac surgery through poking holes at right chest wall and under CPB established through superior vena cava, right femoral artery and vein cannulation is safe and effective with little trauma, little blood loss and blood transfusion, few complications and faster recovery.关键词
心脏外科/微创/全胸腔镜/疗效/老年Key words
cardiac surgery/minimal invasive/totally video-assisted/efficacy/elderly分类
医药卫生引用本文复制引用
刘胜中,谭今,向波,蒋露,曾富春,张晓慎,于涛,黄克力..全胸腔镜心脏手术在老年患者中的临床应用[J].中国现代医学杂志,2018,28(11):60-64,5.基金项目
四川省卫生厅科研课题[No:(2011)110222] （2011）
