完全胸腔镜下室间隔缺损封堵术，无需机器人辅助手术系统：119 例总结。
Totally thoracoscopic closure of ventricular septal defect without a robotically assisted surgical system: a summary of 119 cases.
机构信息
Department of Cardiac Surgery, Qilu Hospital, Shandong University, Jinan, China; School of Biomedical Sciences, Charles Sturt University, Wagga Wagga, New South Wales, Australia; Department of Cardiac Surgery, Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University, Liaocheng, Shandong, China.
Department of Cardiac Surgery, Qilu Hospital, Shandong University, Jinan, China.
出版信息
J Thorac Cardiovasc Surg. 2014 Mar;147(3):863-7. doi: 10.1016/j.jtcvs.2013.10.065. Epub 2013 Dec 6.
OBJECTIVES
To summarize the clinical outcomes of totally thoracoscopic closure of a ventricular septal defect (VSD).
METHODS
Totally thoracoscopic VSD closure was performed in 119 patients (66 boys; mean age, 7.1 ± 3.6 years). An additional 35 patients undergoing open-chest VSD closure were selected as a control group. Using 3 port incisions in the right chest, pericardiotomy, bicaval occlusion, atriotomy, and VSD closure were performed by thoracoscopy without the aid of a robotically assisted surgical system.
RESULTS
Cardiopulmonary bypass and aortic crossclamp times were 42.2 ± 9.8 and 32.5 ± 7.3 minutes, respectively. There were no deaths but 1 patient required insertion of a permanent pacemaker as a result of postoperative atrioventricular conduction block. The length of stay in the intensive care unit (11.0 ± 2.6 vs 22.9 ± 4.9 hours, P < .01) or postoperative hospital stay (4.2 ± 1.1 vs 6.6 ± 2.1 days, P < .03) in the thoracoscopic group were shorter than in the control group. The percentage of patients who required postoperative opioid analgesics in the thoracoscopic group was lower than in the control group (31.9% vs 74.2%, P < .001). Rate of blood transfusion during the operation (17.6% vs 65.7%, P = .001) and the postoperative use of opioid analgesics (31.9% vs 74.3%, P = .003) in the thoracoscopic group was lower than in the control group. Transesophageal echocardiographic analysis 4.6 ± 2.3 months after the operation showed complete closure of the defect.
CONCLUSIONS
Totally thoracoscopic closure of VSD through a 3-port entry was safe and effective.
目的
总结完全胸腔镜下室间隔缺损（VSD）闭合的临床效果。
方法
对 119 例（男 66 例；平均年龄 7.1 ± 3.6 岁）接受完全胸腔镜 VSD 闭合的患者进行研究。选择 35 例接受开胸 VSD 闭合的患者作为对照组。通过右侧胸腔的 3 个切口、心包切开术、双腔静脉阻断、心房切开术和胸腔镜下心室间隔缺损闭合，无需机器人辅助手术系统协助。
结果
体外循环和主动脉阻断时间分别为 42.2 ± 9.8 和 32.5 ± 7.3 分钟。无死亡病例，但 1 例因术后房室传导阻滞需要植入永久性起搏器。胸腔镜组重症监护病房（11.0 ± 2.6 与 22.9 ± 4.9 小时，P<.01）或术后住院时间（4.2 ± 1.1 与 6.6 ± 2.1 天，P<.03）均短于对照组。胸腔镜组术后需要阿片类止痛药的患者比例低于对照组（31.9%比 74.2%，P<.001）。胸腔镜组术中输血率（17.6%比 65.7%，P=.001）和术后阿片类止痛药使用率（31.9%比 74.3%，P=.003）均低于对照组。术后 4.6 ± 2.3 个月行经食管超声心动图分析显示，缺损完全闭合。
结论
通过 3 个端口入口进行完全胸腔镜下 VSD 闭合是安全有效的。
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