Ren Lulu,Shen Li.Recent advances of mini-invasive pediatric cardiac surgery[J].Journal of Clinical Pediatric Surgery,2020,19(10):943-948.[doi:10.3969/j.issn.1671-6353.2020.10.016]
微创手术治疗儿童先天性心脏病的应用进展
- Title:
- Recent advances of mini-invasive pediatric cardiac surgery
- Keywords:
- Surgical Procedures; Minimally Invasive; Heart Diseases/CN; Child
- 分类号:
- R61;R726.2;R654.2;R682.1
- 摘要:
- 儿童先天性心脏病手术目前已较成熟，手术重点已不再是单纯治愈疾病、提高生存率，而是在此基础上减少手术各个阶段的创伤，包括身体创伤及术后伤口瘢痕带来的心理创伤。随着现代医学的发展，先天性心脏病微创手术逐渐发展。微创手术旨在最大限度减轻术中身体创伤，减少并发症，促进快速康复。先天性心脏病微创手术方法主要包括右胸前外侧开胸术、右乳下开胸术、胸骨中线保留手术、右腋下切口开胸术、胸腔镜手术、机器人辅助手术、镶嵌手术。微创手术较传统手术具有创伤小、伤口隐蔽、较美观等优点，在房间隔缺损、室间隔缺损等简单先天性心脏病中应用较多。本文旨在介绍微创手术在儿童先天性心脏病治疗中的应用进展，并对多种微创手术方法进行总结和评价。
- Abstract:
- Recent decades have brought tremendous advances to the field of pediatric cardiac surgery.Instead of simply curing diseases and improving survival rates,the primary objective of surgery is to reduce trauma during all operative stages,including physical intraoperative trauma and mental trauma of wounds and scars.With the rapid development of modern medicine,mini-invasive surgery has been developed for congenital heart disease (CHD).Mini-invasive surgery is designed to minimize physical trauma,reduce complications,promote a rapid recovery,minimize wounds,obtain favorable cosmetic outcomes and avoid mental stress and inferiority complex caused by traditional surgical incisions.Current mini-invasive procedures for CHD include right anterolateral thoracotomy,right submammary thoracotomy,midline sternal-sparing approaches,right subaxillary thoracotomy,video-assisted thoracoscopy and robotically assisted surgery and hybrid procedures,et al.This paper introduced recent advances in the application of mini-invasive pediatric cardiac surgery and reviewed various mini-invasive surgical approaches.
参考文献/References:
1 Dave HH,Comber M,Solinger T,et al.Mid-term results of right axillary incision for the repair of a wide range of congenital cardiac defects[J].Eur J Cardiothorac Surg,2009,35(5):864-870.DOI:10.1016/j.ejcts.2009.01.022.
2 Braile DM,Evora P.The "rebirth" of the right anterolateral thoracotomy approach in cardiac surgery[J].Braz J Cardiovasc Surg,2018,33(2):Ⅰ-Ⅱ.DOI:10.21470/1678-9741-2018-0602.
3 Ding C,Wang C,Dong A,et al.Anterolateral minithoracotomy versus median sternotomy for the treatment of congenital heart defects:a meta-analysis and systematic review[J].J Cardiothorac Surg,2012,7(1):43.DOI:10.1186/1749-8090-7-43.
4 Hong ZN,Chen Q,Lin ZW,et al.Surgical repair via submammary thoracotomy,right axillary thoracotomy and median sternotomy for ventricular septal defects[J].J Cardiothorac Surg,2018,13(1):47.DOI:10.1186/s13019-018-0734-5.
5 Gil-Jaurena JM,Zabala JI,Conejo L,et al.Minimally invasive pediatric cardiac surgery.Atrial septal defect closure through axillary and submammary approaches[J].Rev Esp Cardiol,2011,64(3):208-212.DOI:10.1016/j.recesp.2010.08.009.
6 Vida VL,Tessari C,Fabozzo A,et al.The evolution of the right anterolateral thoracotomy technique for correction of atrial septal defects:cosmetic and functional results in prepubescent patients[J].Ann Thorac Surg,2013,95(1):242-247.DOI:10.1016/j.athoracsur.2012.08.026.
7 Cingoz F,Tavlasoglu M,Sahin MA,et al.Minimally invasive pediatric surgery in uncomplicated congenital heart disease[J].Asian Cardiovasc Thorac Ann,2013,21(4):414-417.DOI:10.1177/0218492312454669.
8 Bleiziffer S,Schreiber C,Burgkart R,et al.The influence of right anterolateral thoracotomy in prepubescent female patients on late breast development and on the incidence of scoliosis[J].J Thorac Cardiovasc Surg,2004,127(5):1474-1480.DOI:10.1016/j.jtcvs.2003.11.033.
9 Kaito T,Shimada M,Ichikawa H,et al.Prevalence of and predictive factors for scoliosis after surgery for congenital heart disease in the first year of life[J].JB JS Open Access,2018,3(1):e45.DOI:10.2106/JBJS.OA.17.00045.
10 Helps BA,Ross-Russell RI,Dicks-Mireaux C,et al.Phrenic nerve damage via a right thoracotomy in older children with secundum ASD[J].Ann Thorac Surg,1993,56(2):328-330.DOI:10.1016/0003-4975(93)91170-R.
11 Li G,Su J,Fan X,et al.Safety and efficacy of ventricular septal defect repair using a cosmetic shorter right lateral thoracotomy on infants weighing less than 5 kg[J].Heart Lung Circ,2015,24(9):898-904.DOI:10.1016/j.hlc.2015.02.010.
12 Naimo PS,Konstantinov IE.Small incisions for small children:is right lateral thoracotomy a right approach in open heart surgery in infants?[J].Heart Lung Circ,2016,25(2):104-106.DOI:10.1016/j.hlc.2015.07.005.
13 Cao H,Zhou Q,Fan F,et al.Right anterolateral thoracotomy:an attractive alternative to repeat sternotomy for high-risk patients undergoing reoperative mitral and tricuspid valve surgery[J].J Cardiothorac Surg,2017,12(1):85.DOI:10.1186/s13019-017-0645-x.
14 Mkalaluh S,Szczechowicz M,Dib B,et al.Early and long-term results of minimally invasive mitral valve surgery through a right mini-thoracotomy approach:A retrospective propensity-score matched analysis[J].Peer J,2018, 6(2):e4810.DOI:10.7717/peerj.4810.
15 Black MD,Freedom RM.Minimally invasive repair of atrial septal defects[J].Ann Thorac Surg,1998,65(3):765-767.DOI:10.1016/s0003-4975(97)01241-1.
16 Gil-Jaurena JM,Gonzalez-Lopez MT,Perez-Caballero R,et al.15 years of minimally invasive paediatric cardiac surgery; development and trends[J].An Pediatr (Barc),2016,84(6):304-310.DOI:10.1016/j.anpedi.2015.06.007.
17 Garcia VM,Cardenas I,Loyola H,et al.Lower mini-sternotomy in congenital heart disease:just a cosmetic improvement?[J].Interact Cardiovasc Thorac Surg,2015,21(3):374-378.DOI:10.1093/icvts/ivv163.
18 Williams PH,Bhatnagar NK,Wisheart JD.Compartment syndrome in a five-year-old child following femoral cannulation for cardiopulmonary bypass[J].Eur J Cardiothorac Surg,1989,3(5):474-475.DOI:10.1016/1010-7940(89)90062-6.
19 程伟,肖颖彬,陈林,等.胸骨下段切口心脏不停跳技术在儿童先心病心内直视手术中的应用[J].临床小儿外科杂志,2016,15(3):235-237.DOI:10.3969/j.issn.1671-6353.2016.03.009. Cheng W,Xiao YB,Chen L,et al.Application of lower sternal incision with on-pump beating heart intracardiac procedures in children of congenital heart disease[J].J Clin Ped Sur,2016,15(3):235-237.DOI:10.3969/j.issn.1671-6353.2016.03.009.
20 Bacha E,Kalfa D.Minimally invasive paediatric cardiac surgery[J].Nat Rev Cardiol,2014,11(1):24-34.DOI:10.1038/nrcardio.2013.168.
21 Pretre R,Kadner A,Dave H,et al.Right axillary incision:a cosmetically superior approach to repair a wide range of congenital cardiac defects[J].J Thorac Cardiovasc Surg,2005,130(2):277-281.DOI:10.1016/j.jtcvs.2005.03.023.
22 An G,Zhang H,Zheng S,et al.Mid-term outcomes of common congenital heart defects corrected through a right subaxillary thoracotomy[J].Heart Lung Circ,2017,26(4):376-382.DOI:10.1016/j.hlc.2015.05.028.
23 Yaliniz H,Topcuoglu MS,Gocen U,et al.Comparison between minimal right vertical infra-axillary thoracotomy and standard median sternotomy for repair of atrial septal defects[J].Asian J Surg,2015,38(4):199-204.DOI:10.1016/j.asjsur.2015.01.008.
24 Hu CX,Tan J,Chen S,et al.Comparison of clinical outcomes and postoperative recovery between two open heart surgeries:minimally invasive right subaxillary vertical thoracomy and traditional median sternotomy[J].Asian Pac J Trop Med,2014,7(8):625-629.DOI:10.1016/S1995-7645(14)60105-X.
25 Silva LF,Silva JP,Turquetto AL,et al.Horizontal right axillary minithoracotomy:aesthetic and effective option for atrial and ventricular septal defect repair in infants and toddlers[J].Rev Bras Cir Cardiovasc,2014,29(2):123-130.DOI:10.5935/1678-9741.20140028.
26 Yang X,Wang D,Wu Q.Repair of partial atrioventricular septal defect through a minimal right vertical infra-axillary thoracotomy[J].J Card Surg,2003,18(3):262-264.DOI:10.1111/j.1540-8191.2002.tb01208.x.
27 An G,Zhang H,Zheng S,et al.Minimally invasive surgical closure for doubly committed subarterial ventricular septal defects through a right subaxillary thoracotomy[J].Interact Cardiovasc Thorac Surg,2016,23(6):924-928.DOI:10.1093/icvts/ivw255.
28 Zhang Q,Zhou ZC,Lin M,et al.Thoracoscope-assisted right vertical infra-axillary mini-incision for cardiac surgery[J].Heart Lung Circ,2015,24(6):590-594.DOI:10.1016/j.hlc.2014.11.020.
29 Nguyen K,Chin C,Lee DS,et al.The axillary incision:a cosmetic approach in congenital cardiac surgery[J].J Thorac Cardiovasc Surg,2007,134(5):1358-1360.DOI:10.1016/j.jtcvs.2007.06.033.
30 Laborde F,Noirhomme P,Karam J,et al.A new video-assisted thoracoscopic surgical technique for interruption of patient ductus arteriosus in infants and children[J].J Thorac Cardiovasc Surg,1993,105(2):278-280.DOI:10.1109/ATEE.2015.7133758.
31 Burke RP,Rosenfeld HM,Wernovsky G,et al.Video-assisted thoracoscopic vascular ring division in infants and children[J].J Am Coll Cardiol,1995,25(4):943-947.DOI:10.1016/0735-1097(94)00461-X.
32 Sabate RA,Burkhart HM,Suri RM,et al.Minimally invasive video-assisted surgical closure of atrial septal defects:a safe approach[J].World J Pediatr Congenit Heart Surg,2014,5(4):527-533.DOI:10.1177/2150135114542166.
33 Liu G,Qiao Y,Ma L,et al.Totally thoracoscopic surgery for the treatment of atrial septal defect without of the robotic Da Vinci surgical system[J].J Cardiothorac Surg,2013,8(1):119.DOI:10.1186/1749-8090-8-119.
34 Moorthy K,Munz Y,Dosis A,et al.Dexterity enhancement with robotic surgery[J].Surg Endosc,2004,18(5):790-795.DOI:10.1007/s00464-003-8922-2.
35 Pike NA,Gundry SR.Robotically assisted cardiac surgery:minimally invasive techniques to totally endoscopic heart surgery[J].J Cardiovasc Nurs,2003,18(5):382-388.DOI:10.1097/00005082-200311000-00010.
36 Le Bret E,Papadatos S,Folliguet T,et al.Interruption of patent ductus arteriosus in children:robotically assisted versus videothoracoscopic surgery[J].J Thorac Cardiovasc Surg,2002,123(5):973-976.DOI:10.1067/mtc.2002.121049.
37 Bonaros N,Schachner T,Oehlinger A,et al.Robotically assisted totally endoscopic atrial septal defect repair:insights from operative times,learning curves,and clinical outcome[J].Ann Thorac Surg,2006,82(2):687-693.DOI:10.1016/j.athoracsur.2006.03.024.
38 Gao C,Yang M,Wang G,et al.Totally robotic resection of myxoma and atrial septal defect repair[J].Interact Cardiovasc Thorac Surg,2008,7(6):947-950.DOI:10.1510/icvts.2008.185991.
39 Dang QH,Le NT,Nguyen CH,et al.Totally endoscopic cardiac surgery for atrial septal defect repair on beating heart without robotic assistance in 25 patients[J].Innovations (Phila),2017,12(6):446-452.DOI:10.1097/IMI.0000000000000436.
40 Xiao C,Gao C,Yang M,et al.Totally robotic atrial septal defect closure:7-year single-institution experience and follow-up[J].Interact Cardiovasc Thorac Surg,2014,19(6):933-937.DOI:10.1093/icvts/ivu263.
41 Bacha EA,Hijazi ZM.Hybrid procedures in pediatric cardiac surgery[J].Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu,2005,8(1):78-85.DOI:10.1053/j.pcsu.2005.01.001.
42 Bearl DW,Fleming GA.Utilizing hybrid techniques to maximize clinical outcomes in congenital heart disease[J].Curr Cardiol Rep,2017,19(8):72.DOI:10.1007/s11886-017-0878-2.
43 Bacha EA,Marshall AC,McElhinney DB,et al.Expanding the hybrid concept in congenital heart surgery[J].Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu,2007:146-150.DOI:10.1053/j.pcsu.2007.01.019.
44 Contrafouris CA,Mitropoulos FA,Chatzis AC,et al.Hybrid procedures for complex congenital cardiac lesions[J].Heart Surg Forum,2009,12(3):E155-E157.DOI:10.1532/HSF98.20091044.
45 Cheatham SL,Deyo GM.Understanding the Hybrid Stage I Approach for Hypoplastic Left Heart Syndrome[J].Crit Care Nurse,2016,36(5):48-55.DOI:10.4037/ccn2016894.
46 Mitropoulos FA,Laks H,Kapadia N,et al.Intraoperative pulmonary artery stenting:an alternative technique for the management of pulmonary artery stenosis[J].Ann Thorac Surg,2007,84(4):1338-1342.DOI:DOI:10.1016/j.athoracsur.2007.04.121.
47 Vida VL,Padalino MA,Maschietto N,et al.The balloon dilation of the pulmonary valve during early repair of tetralogy of Fallot[J].Catheter Cardiovasc Interv,2012,80(6):915-921.DOI:10.1002/ccd.24349.
48 Ramirez PT,Frumovitz M,Pareja R,et al.Minimally invasive versus abdominal radical hysterectomy for cervical cancer[J].N Engl J Med,2018,379(20):1895-1904.DOI:10.1056/NEJMoa1806395.
49 Melamed A,Margul DJ,Chen L,et al.Survival after minimally invasive radical hysterectomy for early-stage cervical cancer[J].N Engl J Med,2018,379(20):1905-1914.DOI:10.1056/NEJMoa1804923.
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备注/Memo
收稿日期:2018-11-25。
基金项目:国家自然科学基金（编号：81371449）
通讯作者:沈立,Email:shenli@shchildren.com.cn