保持胸廓完整性的右前外胸部小切口手术治疗心脏多瓣膜病变  

Right Anterolateral Minithoracotomy with Intact Thorax for Cardiac Multivalvular Disease

作　　者：尤斌[1] 高峰[1] 李平[1] 徐屹[1] 许李力[1] 刘硕[1] 李光[1] 

机构地区：[1]首都医科大学附属北京安贞医院心外科,北京100029

出　　处：《中国微创外科杂志》2013年第5期452-454,457,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨保持胸廓完整性的右前外胸部小切口手术治疗多瓣膜病变的可行性。方法 2010年8月～2012年3月,不劈开胸骨,不横断肋骨,完成右前外胸部小切口多瓣膜手术10例。通过右侧第3肋间5～6 cm横行切口(距胸骨右缘3 cm),腋中线第5肋间1 cm切口,腋中线第3肋间1.5 cm切口,股动、静脉插管建立体外循环,经胸主动脉阻断完成手术。结果 10例均行二尖瓣、主动脉瓣双瓣膜置换,同期完成三尖瓣成形术3例,射频消融术1例。体外循环时间159～291 min,(194.0±42.1)min;主动脉阻断时间126～192 min,(151.3±22.5)min。气管插管时间7～90 h,(22.7±25.4)h;监护室时间8～138 h,(30.1±40.6)h;术后住院时间5～13 d,(7.5±2.4)d。5例输血,2～6 U,(3.6±1.7)U。无围术期死亡。10例随访3～21个月,(9.1±6.9)月,心功能均为Ⅰ级,均无瓣周漏及心动过缓发生。结论保持胸廓完整性的右前外胸部小切口多瓣膜手术可行、安全。Objective To evaluate the feasibility of right anterolateral minithoracotomy with intact thorax for cardiac muhivalvular disease. Methods From August 2010 to March 2012, totally 10 patients with cardia multivalvular disease underwent right anterolateral minithoracotomy in our hospital without cutting the sternum or any ribs. A 5- to 6-cm incision was made in the third right intercostal space, 3 cm away from the right edge of the sternum, and then two incisions were made on the right midaxillary line in the third and fifth intercostal space respectively （1.5 and 1 cm long） to establish port-access cardiopulmonary bypass system for transthoracic aortic clamping. Results Simultaneous mitral and aortic valve replacements were completed in all the ten patients. Concomitant procedures included tricuspid valve plasty （TVP） in 3 patients and radiofrequency ablation in 1 patient. The mean duration of cardiopulmonary bypass and aortic clamping were （ 194.0 ± 42.1 ） rain （ 159 ± 291 min ） and （ 151.3 ± 22.5 ） min （ 126 - 192 min）, respectively. Mean intubation time was （22.7 ±25.4） h （7 -90 h）. After the procedure, the patients stayed in ICU for a mean time of （30.1±40.6） h （8-138 h）; and then were discharged from hospital in （7.5 ±2.4） d （5 -13 d）. Five of the patients received blood transfusion for （3.6 ± 1.7） U （2 - 6 U）. No patient died. A follow-up for （9.1 ± 6.9） months （3 - 21 months） showed grade I cardiac function in all the patients, and no paravalvular leaks or bradycardia occurred during the period. Conclusion Right anterolateral minithoracotomy with intact thorax for cardiac muhivalvular disease is feasible and safe.

关 键 词：微创手术 多瓣膜疾病 改良Port Access技术 前外侧 

分 类 号：R654.2[医药卫生—外科学]