摘要
目的比较单纯二尖瓣病变患者微创与常规二尖瓣成形和置换术的临床效果与安全性。方法回顾性分析中国医科大学附属第一医院2011年1～7月单纯二尖瓣病变患者(不伴有主动脉瓣、三尖瓣病变和其它心脏疾病,房间隔完整)67例的临床资料,按手术方式不同将患者分为两组:微创组,29例,其中男8例、女21例,年龄(51.4±9.4)岁,行右胸前外侧小切口微创二尖瓣成形或置换术;常规组,38例,其中男11例、女27例,年龄(53.6±11.9)岁,行常规胸骨正中切口二尖瓣成形或置换术。微创组行二尖瓣成形术9例,二尖瓣置换术20例,无中转为常规手术病例。常规组行二尖瓣成形术15例,二尖瓣置换术23例。比较两组手术效果和安全性。结果微创组与常规组总手术时间差异无统计学意义[(207.9±18.1)min vs.(198.4±27.5)min,P=0.076)]。微创组术后胸腔引流量[(126.7±34.5)ml vs.(435.6±87.2)ml,P=0.000)]和用血量较常规组减少[红细胞悬液(1.4±0.8)U vs.(2.3±1.1)U,P=0.000,血浆(164.3±50.4)ml vs.(405.6±68.9)ml,P=0.000],且差异有统计学意义。微创组体外循环时间[(81.7±23.9)minvs(.58.7±13.6)min,P<0.05)、主动脉阻断时间较常规组长[(51.6±12.7)min vs.(38.4±11.7)min,P=0.000],且差异有统计学意义。微创组住ICU时间[(22.5±3.6)h vs.(31.7±8.5)h,P=0.000]、术后机械通气时间[(7.4±3.2)h vs.(11.2±5.1)h,P=0.000]、术后住院时间较常规组缩短[(7.1±1.6)d vs.(13.5±2.4)d,P=0.000],且差异有统计学意义。术后两组并发症发生率差异无统计学意义。微创组随访(5.3±2.4)个月,随访率72.4%(21/29);常规组随访(5.5±3.8)个月,随访率71.0%(27/38)。随访期间未见明显并发症。结论经右胸前外侧微创切口行微创二尖瓣成形术和置换术安全有效,美容效果好,术后恢复较常规开胸手术更快、更好。
Objective To compare the clinical outcomes and safety of minimally invasive and routine mitral valve repair or replacement for patients with single mitral valve disease. Methods We retrospectively analyzed the clinical data of 67 patients with single mitral valve disease （without aortic valve and tricuspid valve lesion or other heart diseases including atrial septal defect） who underwent mitral valve repair or replacement in the First Affiliated Hospital of China Medical University between January and July 2011. The patients were divided into two groups according to different sur- gical approaches： the minimally invasive surgery group （n=29, 8 males and 21 females, age 51.4±9.4 years） underwent minimally invasive mitral valve repair or replacement via right mini-thoraetomy; and the routine surgery group （n=38, 11 males and 27 females, age 53.6± 11.9 years） underwent mitral valve repair or replacement via middle stemotomy. In the minimally invasive surgery group, 9 patients underwent mitral valve repair while the other 20 patients underwent mitral valve replacement. And no patient underwent transition to routine operation. In the routine surgery group, 15 patients underwent mitral valve repair and 23 patients underwent mitral valve replacement. Clinical outcomes and safety of the op-erations were compared between the two groups. Results There was no statistical difference in operation time between the two groups （ 207.9 ±18.1 min versus 198.4± 27.5 min, P=0.076）. The amount of postoperative drainage （ 126.7 ±34.5 ml versus 435.6± 87.2 ml, P=0.000） and blood transfusion （ red blood cell 1.4 ±0.8 U versus 2.3±1.1 U, P=0.000; blood plasma 164.3 ±50.4 ml versus 405.6 ±68.9 ml, P=0.000） of the minimally invasive surgery group were significantly lower than those of the routine surgery group. The cardiopulmonary bypass time （ 81.7± 23.9 min versus 58.7±13.6 min, P=-0.000） and aortic-clamping time （51.6±12.7 min versus 38.4± 11.7 min, P=0.000） of the minimally invasive surgery group were significantly longer than those of the routine surgery group. The length of ICU stay （22.5 ±3.6 h versus 31.7± 8.5 h, P=0.000）, mechanical ventilation （7.4 ± 3.2 h versus 11.2 ±5.1 h, P=0.000） and postoperative hospitalization （ 7.1 ±1.6 d versus 13.5 ±2.4 d, P=-0.000） of the minimally invasive surgery group were significantly shorter than those of the routine surgery group. There was no statistical difference in postoperative complications between the two groups. Minimally inva- sive surgery group patients were followed up for 5.3 ± 2.4 months with a follow-up rate of 72.4% （21/29 ）. Routine surgery group patients were followed up for 5.5±3.8 months with a follow-up rate of 71.0% （27/38）. There was no significant complication during follow-up in both two groups. Conclusion Minimally invasive mitral valve operation via right mini-thoracotomy is effective and safe with a good cosmetic result. Compared with routine operation, patients undergoing minimally invasive operation recover better and faster.
出处
《中国胸心血管外科临床杂志》
CAS
2013年第3期294-297,共4页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
关键词
微创
二尖瓣成形术
二尖瓣置换术
单纯二尖瓣病变
Minimally invasive
Mitral valve repair
Mitral valve replacement
Single mitral valve disease
