摘要
目的总结开展胸腔镜心脏手术早期连续100例二尖瓣成形术的临床结果。方法回顾性分析2017年9月至2019年12月连续100例行胸腔镜二尖瓣成形手术患者的临床资料。男56例,女44例;年龄15~75岁,平均(49.2±14.7)岁。通过早期结果评价其安全性和疗效。结果二尖瓣修复技术包括瓣叶折叠5例,叶间裂缝合10例,交界缝合15例,缘对缘缝合1例,人工腱索76例[平均置入人工腱索(2.5±1.6)(1~4)根/例],所有患者均使用成形环。术中经食管超声心动图提示中量及以上反流3例,均再次阻断重新修复成功,少量反流2例,无反流95例,二尖瓣前后叶对合高度均>5 mm。全组体外循环(164.4±51.0)min,主动脉阻断(119.7±39.1)min,最近10例分别为(140.2±45.3)min和(96.3±25.4)min,差异有统计学意义(P<0.05)。手术死亡1例,为术后4 h左心房缝线撕脱。术中转正中开胸止血2例,其中1例上腔静脉插管损伤无名动脉,1例Chitwood阻断钳损伤左心耳。2例患者术后3个月出现重度反流,予以正中开胸行二尖瓣替换术。结论全胸腔镜二尖瓣成形在跨越学习曲线后是一种安全、有效的手术方法,可重复性好,早期结果满意,远期疗效有待进一步随访。
Objective Reported our experience of 100 consecutive cases of thoracoscopic mitral valvuloplasty in the early period.Methods Between September 2017 and December 2019,100 consecutive cases of thoracoscopic mitral valvuloplasty had been completed in our institution.There were 56 males and 44 females.The mean age was(49.2±14.7)years old,ranging from 15 to 75 years old.The safety and feasibility of this technique was evaluated by its early clinical outcomes.Results Mitral valve(MV)repair techniques included leaflet folding in 5 cases,cleft suture in 10,commissuroplasty in 15,edge to edge in 1,artificial chordae implantation in 76 cases with mean of(2.5±1.6)(1-4)pairs,and prosthetic annuloplasty in all cases.Intraoperative transoesophageal echocardiography(TEE)revealed no mitral regurgitation(MR)in 95 cases and a mild in 2 cases with all coaptation length more than 5 mm.The rest 3 cases with moderate or more MR were successfully reconstructed after being blocked again.The mean cardiopulmonary bypass(CPB)time was(164.4±51.0)min and aortic clamping time was(119.7±39.1)min,and the latest 10 cases were(140.2±45.3)min and(96.3±25.4)min,the difference was statistically significant(P<0.05).There was one operative death for avulsion of left atrial suture after operation and 2 intraoperative re-exploration for bleeding.Severe MR was observed in 2 patients 3 months after operation,and mitral valve replacement(MVR)was performed through median sternotomy.Conclusion Totally thoracoscopic mitral valvuloplasty is technically feasible,safe,effective and reproducible in clinical practice after crossing the learning curve.The short-term effect is satisfactory,however,further randomized and long-term follow-up studies are warranted to determine its clinical effects.
作者
崔辉敏
张林
魏士雄
李梁钢
任瞳
姜胜利
Cui Huimin;Zhang Lin;Wei Shixiong;Li Lianggang;Ren Tong;Jiang Shengli(Department of Cardiovascular Surgery,Chinese PLA General Hospital,Beijing 100853,China)
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2021年第9期542-545,共4页
Chinese Journal of Thoracic and Cardiovascular Surgery
基金
解放军总后勤部卫生部科研基金(16BJZ28)。
关键词
胸腔镜
微创
二尖瓣成形术
Thoracoscopy
Minimally invasive surgical procedures
Mitral valvuloplasty
