经胸骨下段正中小切口行心脏瓣膜手术  

Limited Lower Sternotomy for Minmally Invasive Valve Operation

作　　者：吕锋[1] 吴清玉[1] 王小启[1] 马琼[1] 

机构地区：[1]中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院心外科,北京市100037

出　　处：《中国循环杂志》2000年第2期106-107,共2页Chinese Circulation Journal

摘　　要：目的：探讨经胸骨下段正中小切口行各种心脏瓣膜手术的适应证和手术方法。 方法：３０例患者平均年龄４２．２±１０．１（１７～５８）岁。皮切口自第３胸肋关节水平至剑突根部，平均长度１１（９～１３）ｃｍ，自下而上纵行劈开胸骨至第２肋间处向右侧横断。手术于常规体外循环下进行，包括二尖瓣置换１９例，主动脉瓣置换３例，主动脉瓣及二尖瓣双瓣置换６例，二尖瓣Ｃａｒｐｅｎｔｉｅｒ环成形２例。７例同时行三尖瓣ＤｅＶｅｇａ环缩术。４例同时行左心房血栓清除。 结果：无手术死亡及并发症。平均主动脉阻断、体外循环和手术时间分别为５４．５±２４．９分、７９．２±２８．７分和１６０．９±４４．３分，术后呼吸机辅助１０．７±４．２小时，住院时间 １４．４±４．９天。术后胸液量２８２±１２５（５０～６３０）ｍｌ，有１６例患者（５３．３％）未输血。 结论：经胸骨下段正中小切口行心脏瓣膜手术安全可靠，美观，创伤小，出血少，保留了胸廓的连续性，早期结果满意。Objective:To review the indications,operative methods and clinical results of 30 patients underwent minimally inva- sive valve operation. Methods: Between August and December 1998, 30 consecutive patients underwent limited lower sternotomy for valve operation. The age ranged from 17 to 58 years with a mean of 42.2±10.1 years. A 11 cm (ranged 9 to 13 cm) mid- line incision was made from the third rib to the base of xiphoid process. A transverse half sternotomy was made in the second intercostal space from the right border to the center of the sternum. Cardiopulmonary bypass was connected through the same access. Operations included mitral valve replacement (MVR) in 19 patients,aortic valve replacement (AVR) in 3,MVR and AVR in 6,and mitral valvuloplasty in 2. Additional procedures included tricuspid valvuloplasty in 7 patients and left atrial thrombectomy in 4 patients. Results: There were neither intraoperative complications nor hospital death. Aortic cross-clamp time, cardiopul- monary bypass time,and operation time from skin to skin averaged 54.5±24.9, 79.2± 28. 7,and 160.9 ±44. 3 minutes, respectively. All patients could be extubated in the intensive care unit (ICU) at an average of 10.7±4. 2 hours and dis- charged at an average of 14.4±4. 9 days. The median blood loss was 282±125 ml (range,50 to 630 ml) and in 16 pa- tients no homologous blood transfusion was needed. Conclusion: Limited lower sternotomy is a safe alternative method for minimally invasive valve operation which is cosmetically acceptable and permits easy access to the entire heart,the sternum is stable,the surgical trauma and postop- erative blood loss are reduced,and a standard median sternotomy can be easily performed whenever necessary.

关 键 词：小切口 心脏瓣膜手术 

分 类 号：R654.2[医药卫生—外科学]