闭式体外循环下微创与常规主动脉瓣手术的疗效对比分析  

Port-access minimally invasive versus sternotomy approach for aortic valve surgery

作　　者：邱志兵[1] 陈鑫[1] 秦卫[1] 黄福华[1] 汪黎明[1] 蒋英硕[1] 徐明[1] 肖立琼[1] 祁浩宇 尹力[1] Qiu Zhibing;Chen Xin;Qin Wei;Huang Fuhua;Wang Liming;Jiang Yingshuo;Xu Ming;Xiao Liqiong;Qi Haoyu;Yin Li(Department of Cardiovascular Surgery,Nanjing Hospital Affiliated to Nanjing Medical University,Nanjing First Hospital,Nanjing 210006,China)

机构地区：[1]南京医科大学附属南京医院南京市第一医院心血管外科,210006

出　　处：《中国医师杂志》2019年第1期40-43,共4页Journal of Chinese Physician

基　　金：江苏省高层次卫生人才"六个一工程"拔尖人才科研项目A类(LGY2017002);南京市科技发展计划项目(201715027)~~

摘　　要：目的对比分析闭式体外循环经右胸微创主动脉瓣手术与同期常规主动脉瓣手术早期疗效,评估经右胸微创切口手术治疗主动脉瓣疾病的可行性和安全性。方法前瞻性分析2017年1月至12月选择性实施单纯主动脉瓣手术的60例患者的临床资料和早期随访结果。其中男32例,女28例;年龄28～72(46. 5±10. 2)岁。采用随机表法将患者分成采用闭式体外循环下经右胸微创切口主动脉瓣手术组(微创组,20例)和常规单纯主动脉瓣手术组(常规组,40例)。微创组所有手术均经股动静脉、右颈内静脉插管建立闭式体外循环,取右侧胸骨旁第3肋间长5～6 cm的横切口完成主动脉瓣替换术。常规组手术经胸骨正中切口常规建立体外循环,完成主动脉瓣替换术;比较分析两组围术期临床资料、并发症和死亡率。结果全组无围术期及出院后近期死亡,微创组体外循环时间[(106. 0±21. 0) min vs (73. 0±15. 0) min]和主动脉阻断时间[(78. 0±10. 0) min vs(47. 0±6. 0) min]较常规组延长(P <0. 05);而微创组术后辅助呼吸时间[(7. 0±4. 2) h vs (10. 2±5. 3) h]、住ICU时间[(19. 0±4. 0) h vs (27. 5±8. 0) h]和术后住院时间[(8. 5±2. 5) d vs (13. 0±3. 0) d]较常规组缩短(P <0. 05)。微创组术后12 h引流量[(100. 0±40. 0) ml vs (410. 0±80. 0)ml]、输血率(15. 0%vs 55. 0%)较常规组减少(P <0. 05)。术后随访1～12个月,随访率96. 7%,两组早期并发症发生率和生存率差异无统计学意义(P> 0. 05)。结论经右胸微创切口直视治疗主动脉瓣疾病是安全、可行的。在达到与传统开胸手术相同效果的前提下,微创手术明显恢复快,减少血制品使用,值得临床推广应用。Objective To compare early outcomes of the minimally invasive aortic valve surgery (MIAVS)through right parasternal mini-thoracotomy with conventional mitral valve surgery (AVS),and evaluate feasibility and safety of MIAVS.Methods From January 2017 to December 2017,60 patients undergoing elective AVS in Nanjing First Hospital were prospectively enrolled in this study.There were 32 male and 28 female patients with their age of 28 -72 (46.5 ±10.2)years.Using a random number table, all the patients were randomly divided into a port-access MIAVS group (MIAVS group,n =20)and a conventional AVS group (conventional group,n =60).MIAVS group patients received port-access cardiopulmonary bypass (CPB)establishment via femoral artery,femoral vein and right internal jugular vein cannulation through right the 3rd in tercostal space with 5 -6 cm right parasternal incision in length.Special MIAVS operative instruments were used for mitral valve repair or replacement.Conventional group patients received mitral valve repair or replacement under conventional CPB through median sternotomy.Perioperative clinical data,morbidity and mortality were compared between the 2 groups.Results There was no death in-hospital or shortly after discharge in this study.CPB time [(106.0 ±21.0)minutes vs (73.0 ±15.0) minutes]and aortic cross-clamping time [(78.0 ±10.0)minutes vs (47.0±7.0)minutes]of MIAVS group were significantly longer than those of conventional group (P <0.05).Postoperative mechanical ventilation time [(7.0 ±4.2)hours vs (10.2 ±5.3 )hours ],length of intensive care unit (ICU)stay [(19.0 ±4.0)hours vs (27.5 ±8.0)hours]and postoperative hospital stay [(8.5 ±2.5)days vs (13.0 ±3.0) days ]of MIAVS group were significantly shorter than those of conventional group (P <0.05 ).Chest drainage volume within postoperative 12 hours [(100.0 ±40.0)ml vs (410.0 ±80.0)ml]and the percentage of patients receiving blood transfusion (15.0%vs 55.0%)of MIAVS group were significantly lower than those of conventional group (P <0.05).Patients w

关 键 词：心肺转流术 外科手术 微创性 心脏瓣膜假体植入 主动脉瓣关闭不全 主动脉瓣 狭窄 

分 类 号：R654.2[医药卫生—外科学]