| Objectives:Through the comparative study to the experiment of 10 dogs with total thoracoscope cardiac surgery,20 cases clinical total thoracoscope heart surgery, and 20 cases clinical similar patients with open-chest surgery,this subject aims to explore-. (1) Through animal experiments,we study the risk factors and intraoperative difficulties of early thoracoscopic cardiac surgery under cardiopulmonary bypass.then present guiding recommendations to the new unit of VATS cardiac surgery, and further verify the feasibility of minimally invasive cardiac surgery.(2) Through the comparative analysis of two sets of data,we find the advantages and disadvantages of minimally invasive surgery compared with traditional operation mode.Methods:(1) Animal experiments:10 adult mongrel dogs, either male or female, weight 16-30kg or so, All intramuscular injection with ketamine hydrochloride injection, tracheal intubation, Ventilator small tide volume high frequency ventilation method, stripping right femoral artery and femoral vein, establish extracorporeal circulation, on the third and seventh rib clearance of right axillary midline, and the fifth rib clearance beside of the sternum, cut a 2cm small incision respectively respectively for surgical instruments holes and thoracoscope placed holes. Simulate thoracoscope cardiac surgery,and record risk factors encountered in the process of surgery that can cause the experiment fails or unable to continue, and seek solutions.(2) Clinical application:clinically choose 20 cases Thoracoscope cardiac surgery patients, Traditional heart surgery case 20 cases.(the weight,age,disease of two groups patients are generally similar). Record the two groups operating time, postoperative hospitalization time, postoperative ICU time, surgical trauma, hospital ization expenses, etc, to compare the pros and cons of the two operation method.Results:(1)Animal experiments:10 dogs are made arterial septal defect artificially and are repaired under the video-assisted thoracoscopic surgery (VATS),CPB;three experiments fails,the reasons for failure are the rupture and bleeding of the superior vena cava and inferior vena cava.Aorta bleeds when seaming pouch. (2)Clinical application:The patients'preoperative EF of TTS groups is 59±4.2 (%),the postoperative EF of them is 57.8±2.9 (%), The patients'preoperative EF of MS groups is 59±3.6 (%). the postoperative EF of them is 58.1±3.1 (%). The hospitalization time of TTS patients is 12.65±3.44 (d), The hospitalization time of MS patients is 13.6±2.14 (d). The time of ventilator assisted respiration in TTS group is 7.28±4.28 (min),The time of ventilator assisted respiration in MS group is 6.99±2.75 (min). The operation time in TTS patients is 158±42.03 (min), MS group's operation time is 110.3±20.26 (min). aorta blocking time in TTS group is 30.8±14.55 (min), MS group's aorta blocking time is 14.55±9.86 (min). The postoperative ICU time of TTS groups'patients is 1.3±0.47(d), The postoperative ICU time of MS groups'patients is 1.75±0.78 (d).Conclusions:(1)Animal experiments:Through animal experiments,we further verify the feasibility of minimally invasive cardiac surgery, practise the operation and mutual cooperation.The subject bridges this technology to clinic.(2)Clinical application:The operative time,aorta blocking time in TTS group are longer than them in MS group, The postoperative ICU time in TTS group is shorter than it in MS group; There is no significant differences in two groups'hospitalization time and'time of ventilator assisted respiration. There is no significant differences in the two methods'influence to EF before and after operation... |
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