摘要
目的对比分析微创二尖瓣手术与同期常规二尖瓣手术的早期疗效,评估微创手术治疗二尖瓣疾病的可行性和安全性。方法前瞻性分析南京市第一医院2011年1月至2013年12月选择性实施单纯二尖瓣手术患者的临床资料和早期随访结果。共纳入120例患者,其中男72例,女48例;年龄22~71（42.4±11.0）岁。采用随机表法将患者分为闭式体外循环下直视微创二尖瓣手术组（微创组,60例）和常规单纯二尖瓣手术组（常规组,60例）。微创组所有手术均经股动脉、股静脉、右颈内静脉插管建立闭式体外循环,取右前外侧第4肋间长5~6 cm的切口,用特制微创心脏外科手术器械完成二尖瓣修复或置换术。常规组手术经胸骨正中切口常规建立体外循环,完成二尖瓣修复或置换术。比较分析两组围术期临床资料、并发症和死亡率。结果全组无围术期及出院后近期死亡,微创组平均体外循环时间[（98.0±26.0）min vs.（63.0±21.0）min]和平均主动脉阻断时间[（68.0±9.0）min vs.（37.0±6.0）min]较常规组显著延长（P〈0.05）;微创组术后平均机械通气时间[（6.0±3.9）h vs.（11.2±5.6）h]、住ICU时间[（18.5±3.0）h vs.（28.6±9.5）h]和术后平均住院时间[（8.0±2.0）d vs.（13.5±2.5）d]较常规组显著缩短（P〈0.05）。而微创组术后12 h平均胸腔引流量[（110.0±30.0）ml vs.（385.0±95.0）ml]、输血率[25.0%vs.58.3%]较常规组显著减少（P〈0.05）。术后随访1~24个月,随访率94.2%,两组早期并发症发生率和生存率差异无统计学意义（P〉0.05）。结论经右胸微创切口直视治疗二尖瓣疾病是安全、可行的。在达到与传统开胸手术相同效果的前提下,微创手术明显缩短患者术后住ICU时间和住院时间,减少血液制品使用,值得临床推广应用。
Objective To compare early outcomes of the minimally invasive mitral valve surgery（MIMVS） through right anterolateral mini-thoracotomy（ALMT） with conventional mitral valve surgery（MVS）, and evaluate feasibility and safety of MIMVS. Methods From January 2011 to December 2013, 120 patients undergoing elective MVS in Nanjing First Hospital were prospectively enrolled in this study. There were 72 male and 48 female patients with their age of 22-71（42.4±11.0） years. Using a random number table, all the patients were randomly divided into a portaccess MIMVS group（MIMVS group, n=60） and a conventional MVS group（conventional group, n=60）. MIMVS group patients received port-access cardiopulmonary bypass（CPB） establishment via femoral artery, femoral vein and right internal jugular vein cannulation through right ALMT 5-6 cm in length. Special MIMVS operative instruments were used for mitral valve repair or replacement. Conventional group patients received mitral valve repair or replacement under conventional CPB through median sternotomy. Perioperative clinical data, morbidity and mortality were compared between the 2 groups. Results There was no death in-hospital or shortly after discharge in this study. CPB time（98.0±26.0 minutes vs. 63.0±21.0 minutes） and aortic cross-clamping time（68.0±9.0 minutes vs.37.0±6.0 minutes） of MIMVSgroup were significantly longer than those of conventional group（P〈0.05）. Postoperative mechanical ventilation time（6.0±3.9 hours vs. 11.2±5.6 hours）, length of ICU stay（18.5±3.0 hours vs. 28.6±9.5 hours） and postoperative hospital stay（8.0±2.0 days vs. 13.5±2.5 days） of MIMVS group were significantly shorter than those of conventional group（P〈0.05）. Chest drainage volume within postoperative 12 hours（110.0±30.0 ml vs. 385.0±95.0 ml） and the percentage of patients receiving blood transfusion（25.0% vs. 58.3%） of MIMVS group were significantly lower than those of conventional group（P〈0.05）. Patients were followed
出处
《中国胸心血管外科临床杂志》
CAS
CSCD
2015年第1期4-8,共5页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
基金
国家自然科学基金资助项目(81270192)~~
关键词
微创
闭式体外循环
二尖瓣手术
小切口
随机对照试验
Minimally invasive surgery
Port-access cardiopulmonary bypass
Mitral valve surgery
Small incision
Randomized controlled trial
