微创心脏外科手术中的体外循环技术应用(1)
[摘要] 目的 探讨体外循环技术应用于微创心脏手术中的价值，总结微创心脏手术的体外循环管理经验。 方法 选择2012年1月～2016年3月在华中科技大学同济医学院附属同济医院行体外循环辅助下微创心脏手术的患者121例，其中全腔镜手术91例，小切口胸腔镜辅助手术28例，达芬奇机器人辅助手术2例；主动脉瓣置换术3例，二尖瓣置换术68例，二尖瓣成形术5例，房间隔缺损修补术33例，室间隔缺损修补术12例；年龄17～64岁，男69例，女52例；均在股动脉、股静脉插管建立体外循环的辅助下完成手术。 结果 体外循环转流时间为(91.37±47.24)min，主动脉阻断时间为(57.63±34.66)min。全部病例体外循环停机均顺利，并安全完成手术。 结论 针对微创心脏手术的特点，改良技术细节并合理选用辅助设备，周围体外循环技术可安全顺利地辅助目前主要的微创心脏手术。
[关键词] 体外循环；微创心脏外科；房间隔缺损；二尖瓣置换术
[中图分类号] R654.2 [文献标识码] A [文章编号] 1673-7210(2016)12(b)-0058-03
Application of extracorporeal circulation technique in minimally invasive cardiac surgery
WANG Yuan ZHOU Manling
Department of Cardiovascular Surgery， Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology， Hubei Province， Wuhan 430030， China
[Abstract] Objective To explore the value of extracorporeal circulation technique in minimally invasive cardiac surgery， and to summarize the experience of extracorporeal circulation management of minimally invasive cardiac surgery. Methods 121 cases undergoing minimally invasive cardiac surgery assisted by extracorporeal circulation in Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from January 2012 to March 2016 were selected， among whom， there were 91 cases of total laparoscopic surgery， 28 cases of thoracic small incision assisted surgery， 2 cases of Da Vinci robot assisted surgery； there were 3 cases of aortic valve replacement， 68 cases of mitral valve replacement， 5 cases of mitral valvuloplasty， 33 cases of repair of atrial septal defect， 12 cases of ventricular septal defect repair； aged 17-64 years old， with 69 cases of male and 52 cases of female. In the femoral artery and femoral vein， the catheter was set up in cardiopulmonary bypass to complete the operation. Results The cardiopulmonary bypass time was (91.37±47.24) min， aortic blocking time was (57.63±34.66) min. All cases of extracorporeal circulation stopped smoothly and completed the operation safely. Conclusion In view of the characteristics of minimally invasive cardiac surgery， the improvement of technical details and reasonable selection of auxiliary equipment， peripheral cardiopulmonary bypass technology can assist the current major minimally invasive cardiac surgery safely and smoothly.
[Key words] Extracorporeal circulation； Minimally invasive cardiac surgery； Atrial septal defect； Mitral valve replacement
近年來微创手术因其手术创伤小、恢复较快以及伤口对患者外观影响小，成为外科手术的发展方向。手术机器人技术的应用，也将全腔镜微创外科推向了发展新高峰[1]。心脏外科的微创技术也在国内越来越多的单位开展。但大多数心内手术需在体外循环下完成，而微创条件下，无论是常规插管建立体外循环，术中保证体外循环的充足引流及合适的动脉流量，以及因相对常规手术而增加的体外循环时间，均使得体外循环成为束缚心外微创手术特别是全腔镜手术广泛应用的一大技术瓶颈。而随着技术进步、各类插管及其技术的改良、辅助引流等技术的推广，周围体外循环技术正为微创心脏外科的进步提供有力保障。, 百拇医药(汪源 周曼玲)
[关键词] 体外循环；微创心脏外科；房间隔缺损；二尖瓣置换术
[中图分类号] R654.2 [文献标识码] A [文章编号] 1673-7210(2016)12(b)-0058-03
Application of extracorporeal circulation technique in minimally invasive cardiac surgery
WANG Yuan ZHOU Manling
Department of Cardiovascular Surgery， Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology， Hubei Province， Wuhan 430030， China
[Abstract] Objective To explore the value of extracorporeal circulation technique in minimally invasive cardiac surgery， and to summarize the experience of extracorporeal circulation management of minimally invasive cardiac surgery. Methods 121 cases undergoing minimally invasive cardiac surgery assisted by extracorporeal circulation in Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from January 2012 to March 2016 were selected， among whom， there were 91 cases of total laparoscopic surgery， 28 cases of thoracic small incision assisted surgery， 2 cases of Da Vinci robot assisted surgery； there were 3 cases of aortic valve replacement， 68 cases of mitral valve replacement， 5 cases of mitral valvuloplasty， 33 cases of repair of atrial septal defect， 12 cases of ventricular septal defect repair； aged 17-64 years old， with 69 cases of male and 52 cases of female. In the femoral artery and femoral vein， the catheter was set up in cardiopulmonary bypass to complete the operation. Results The cardiopulmonary bypass time was (91.37±47.24) min， aortic blocking time was (57.63±34.66) min. All cases of extracorporeal circulation stopped smoothly and completed the operation safely. Conclusion In view of the characteristics of minimally invasive cardiac surgery， the improvement of technical details and reasonable selection of auxiliary equipment， peripheral cardiopulmonary bypass technology can assist the current major minimally invasive cardiac surgery safely and smoothly.
[Key words] Extracorporeal circulation； Minimally invasive cardiac surgery； Atrial septal defect； Mitral valve replacement
近年來微创手术因其手术创伤小、恢复较快以及伤口对患者外观影响小，成为外科手术的发展方向。手术机器人技术的应用，也将全腔镜微创外科推向了发展新高峰[1]。心脏外科的微创技术也在国内越来越多的单位开展。但大多数心内手术需在体外循环下完成，而微创条件下，无论是常规插管建立体外循环，术中保证体外循环的充足引流及合适的动脉流量，以及因相对常规手术而增加的体外循环时间，均使得体外循环成为束缚心外微创手术特别是全腔镜手术广泛应用的一大技术瓶颈。而随着技术进步、各类插管及其技术的改良、辅助引流等技术的推广，周围体外循环技术正为微创心脏外科的进步提供有力保障。, 百拇医药(汪源 周曼玲)