右胸小切口瓣膜置换手术23例临床分析  

Clinical analysis of 23 cases with valve replacement through right minithoracotomy

作　　者：李寒[1] 汤楚中[1] 解水本[1] 赵哲[1] 迟海涛[1] 潘绪[1] 孙文婷[1] 

机构地区：[1]海军总医院心脏中心,北京100048

出　　处：《北京医学》2013年第7期515-517,共3页Beijing Medical Journal

摘　　要：目的总结经右胸小切口行瓣膜置换术的临床经验。方法选择2011年5月至2012年12月收治的23例在体外循环下经右胸小切口行瓣膜置换术患者,其中风湿性心脏病二尖瓣狭窄8例,风湿性心脏病二尖瓣关闭不全5例,风湿性心脏病主动脉瓣狭窄4例,先天性心脏病主动脉瓣狭窄3例,风湿性心脏病主动脉瓣关闭不全3例。行二尖瓣置换术13例,主动脉瓣置换术10例。13例同期行三尖瓣DeVega环缩术。手术切口长5～6cm,左端起自胸骨旁1cm,沿第3肋间。选择同期78例接受常规瓣膜置换手术患者作为对照组。结果全组无死亡病例,主动脉阻断时间40～86min,平均(55±8)min,体外循环时间60～115min,平均(80±9)min;体外循环及主动脉阻断时间均长于对照组[(38±4)min,(58±4)min,P﹤0.001]。术中平均失血(368.4±15.3)ml,显著少于对照组[(412.1±19.6)ml,P﹤0.001]。结论经右胸小切口行心脏手术安全可行,创伤小、美观、恢复时间短,但体外循环时间过长。Objective To summarize the experience of valve replacement through right minithoracotomy.Methods Twenty-three patients with heart disease who underwent valve replacement through right minithoracotomy were included.The incision was 5-6 cm long across the third intercostal space and 1 cm apart from the the parasternal line.The study included 8 cases of rheumatic mitral stenosis,5 cases of mitral regurgitation,4 cases of rheumatic aortic stenosis,3 cases of aortic stenosis associated with congenital heart diseases,3 cases with rheumatic aortic valve regurgitation,and 13 cases of them were performed De Vega banding surgery to tricuspid valve at the same operation.Results There was no death in all patients.Aortic clamp time was 40～86 min,the average time was（55±8.2）min.The cardiopulmonary bypass time was 60～115 min,the average was（80.4±9.2）min.Conclusion Cardiac surgical procedures through right minithoracotomy is feasible and safe,with minimal invasive,and shorter recovery time.

关 键 词：右胸小切口 微创 心脏手术 体外循环 

分 类 号：R654.2[医药卫生—外科学]