摘要
目的研究胸腔镜联合经食管超声心动图在肥厚型梗阻性心肌病Morrow手术中的应用价值。方法2017年1月至2019年12月我院心胸外科同一医疗组对肥厚型梗阻性心肌病患者分成两组进行手术,A组采用胸腔镜下微创手术,B组采用正中开胸手术。A组采用食管超声心动图对左室流出道梗阻及二尖瓣反流的诊断描述,对照胸腔镜的探查结果,分析胸腔镜联合经食管超声心动图在Morrow手术的应用价值。结果A组30例患者二尖瓣反流(MR)与左室流出道峰值压差(LVOT-PG)呈正相关。左心室舒张末期前后径(LVEDd)较术前增大,左心室射血分数(LVEF)较术前略减低,室间隔基底段舒张末期厚度(IVSd)、左室流出道峰值流速(LVOT-PV)、左室流出道峰值压差(LVOT-PG)、二尖瓣反流面积(MR)较术前明显降低;A组与B组相比体外循环时间、主动脉阻断时间、胸部切口长度较小,差异均有统计学意义(P<0.05)。结论胸腔镜联合经食管超声心动图的Morrow手术是一种有效、可行的治疗肥厚型梗阻性心肌病的手术方式。手术创伤小、术后恢复快,TEE对二尖瓣病变能做出准确的判断,有利于手术方式的抉择,值得在临床推广。
Objective To investigate the value of thoracoscopy combined with transesophageal echocardiography in the operation of hypertrophic obstructive cardiomyopathy Morrow surgery.Methods From January 2017 to December 2019,the patients with hypertrophic obstructive cardiomyopathy were divided into two groups for surgery by the same medical group in our hospital′s cardiothoracic surgery department.Group A underwent thoracoscopic minimally invasive surgery,and group B underwent median thoracotomy.In group A,the diagnosis of left ventricular outflow tract obstruction and mitral regurgitation were described by esophageal echocardiography.The application value of thoracoscopy combined with transesophageal echocardiography in Morrow surgery was analyzed by comparing the results of thoracoscopic exploration.Results Mitral regurgitation(MR)was positively correlated with left ventricular outflow tract peak pressure difference(LVOT-PG)in 30 patients of group A.Compared with that before surgery,the left ventricular end-diastolic diameter(LVEDd)increased,left ventricular ejection fraction(LVEF)slightly decreased,and ventricular septal basal end-diastolic thickness(IVSd),left ventricular outflow tract peak velocity(LVOT-PV),left ventricular outflow tract peak pressure difference(LVOT-PG),mitral regurgitation area(MR)significantly decreased.Compared with that of group B,extracorporeal circulation time,aorta occlusion time,and chest incision length were shorter in group A.The above differences were statistically significant(P<0.05).Conclusion The Morrow surgery with thoracoscopy and transesophageal echocardiography is an effective and feasible surgical method for hypertrophic obstructive cardiomyopathy,which has small operation trauma,and fast postoperative recovery.TEE can make an accurate judgment of mitral valve disease,which is conducive to the choice of surgical mode and worthy of clinical promotion.
作者
王嶒
孙婷婷
王静
范小明
WANG Ceng;SUN Tingting;WANG Jing;FAN Xiaoming(Department of Ultrasound,Zhejiang Provincial People′s Hospital,Affiliated People′s Hospital,Hangzhou Medical College,Hangzhou310014,China)
出处
《中国现代医生》
2021年第28期122-125,共4页
China Modern Doctor
基金
浙江省基础公益研究计划项目(LGF19H160026)
浙江省教育厅一般科研项目(Y201738347)
浙江省中医药优秀青年人才基金项目(2018ZQ005)。
关键词
肥厚型梗阻性心肌病
胸腔镜
经食管超声心动图
二尖瓣
Hypertrophic obstructive cardiomyopathy
Thoracoscopy
Transesophageal echocardiography
Mitral valve
