右胸前外侧微创小切口二尖瓣成形术的疗效分析  

Clinical Outcomes of Minimally Invasive Mitral Valvuloplasty via Right Anterolateral Minithoracotomy

作　　者：刘洪端[1] 李新[1] 于风旭[1] 邓明彬[1] 刘立明[2] 

机构地区：[1]泸州医学院附属医院胸心外科,四川泸州646000 [2]中南大学湘雅二医院胸心外科,长沙410011

出　　处：《中国胸心血管外科临床杂志》2014年第2期194-197,共4页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的 分析经右胸前外侧微创小切口行二尖瓣成形术的临床疗效。 方法 回顾性分析2011年1月至2013年2月我院经右胸前外侧微创小切口行二尖瓣成形术的23例心脏瓣膜病患者的临床资料，男8例、女15例，年龄 （41±10） 岁。采用右胸前外侧微小切口 （4～6 cm），股动、静脉建立体外循环，经胸阻断主动脉，灌注冷血心脏停搏液，右上肺静脉行左心房引流，经房间隔行二尖瓣成形术，三尖瓣反流予以成形。 结果 23例手术均获成功，无死亡病例。手术时间160～290 （229±37） min，升主动脉阻断时间40～121 （67±19） min，体外循环时间 60～136 （87±21） min，术后呼吸机辅助时间6～47 （16±11） h，重症监护室停留时间19～60 （30±12） h，术后胸腔引流量80～780 （320±184） ml。术后复查心脏彩色超声心动图提示左心室射血分数49%～65%（56.0%±4.8%），二尖瓣轻微反流5例，三尖瓣轻度反流6例。术后1个月右胸切口长度3.9～6.0 （5.3±0.7） cm。术后随访1～24个月，复查超声心动图未见二尖瓣中至重度反流。 结论 经右胸行小切口二尖瓣成形术切口小，美容效果好，安全可行，疗效肯定。Objective To analyze clinical outcomes of mitral valvuloplasty （MVP） via right anterolateral minithoracotomy. Methods Clinical data of 23 patients with valvular heart disease who underwent minimally invasive MVP via right anterolateral minithoracotomy from January 2011 to February 2013 in the Department of Cardiothoracic Surgeryin our hospital were retrospectively analyzed. There were 8 males and 15 females with mean age of 41±10 years. Theprocedure was performed through a small （4-6 cm） incision via right anterolateral minithoracotomy. Cardiopulmonary bypass （CPB） was established via femoral artery and vein cannulation. Transthoracic clamp was used for ascending aortic clamping. Cold blood cardioplegia was delivered after aortic cross-clamping. Left atrial drainage was established through right superior pulmonary vein. MVP was performed through the atrial septal approach,and tricuspid valvuloplasty was performed for tricuspid regurgitation if necessary. Results All the operations were successfully performed withoutin-hospital death. Operation duration was 160-290 （229±37） minutes. Aortic cross-clamping time was 40-121 （67±19） minutes. CPB duration was 60-136 （87±21） minutes. Postoperative mechanical ventilation time was 6-47 （16±11） hours. The length of intensive care unit stay was 19-60 （30±12） hours. Postoperative chest drainage was 80-780 （320±184） ml. Postoperative color Doppler echocardiography showed that left ventricular ejection fraction was 49%-65% （56.0%±4.8%）. There were 5 patients with trivial mitrial valve regurgitation and 6 patients with mild tricuspid valve regurgitation. Posto-perative mean length of the right thoracic incision was 3.9-6.0 （5.3±0.7） cm. The patients were followed up for 1-24 months.The result of echocardiography showed no modern to severe valve regurgitation. Conclusion Minimally invasive MVP via right anterolateral minithoracotomy is safe and feasible with satisfactory cosmetic and clinical results.

关 键 词：微创手术 右胸前外侧小切口 二尖瓣成形术 体外循环 

分 类 号：R654.2[医药卫生—外科学]