微创直视主动脉瓣置换术在主动脉瓣病变患者中的临床应用  

Clinical application of minimally invasive aortic valve replacement through right parasternal longitudinal small incision for patients with aortic valve disease

作　　者：刘胜中[1] 谭今[1] 向波[1] 蒋露[1] 张晓慎[1] 于涛[1] 黄克力[1] 

机构地区：[1]四川省医学科学院(四川省人民医院)心脏外科中心,四川成都610072

出　　处：《中国现代医学杂志》2017年第5期73-77,共5页China Journal of Modern Medicine

摘　　要：目的总结经右侧胸骨旁纵行小切口行微创直视主动脉瓣置换术的临床经验,并评价其安全性和疗效。方法 2014年12月-2016年3月,8例主动脉瓣病变患者接受了微创直视主动脉瓣置换术。男5例,女3例,年龄(45.12±9.09)岁。患者采用全身麻醉双腔气管插管,颈内静脉及股动、静脉插管建立体外循环右侧胸骨旁第2~3肋间隙纵行小切口(4~6 cm)进胸,直视下完成主动脉瓣置换术。结果全组无中转前正中开胸,无死亡,均痊愈出院。患者体外循环时间(102.87±29.88)min,主动脉阻断(69.00±20.98)min,手术时间(248.12±69.69)min,术后呼吸机辅助(10.42±3.08)h,术后重症监护病房(ICU)停留(17.56±3.19)h,术后住院(8.00±2.87)d。术中失血量(212.50±84.64)ml,术后24h胸腔引流量(195.46±60.38)ml,胸腔引流管留置时间(2.32±0.55)d;4例患者未输血,平均输血量(218.75±247.76)ml。切口平均长度(4.92±0.88)cm。出院前复查无瓣周漏及人工瓣膜功能障碍。8例随访(11.50±4.37)个月无死亡,心功能恢复至Ⅰ级,人工瓣膜未见异常。结论部分主动脉瓣病变患者采用外周血管插管建立体外循环,经右侧胸骨旁纵行小切口完成微创直视主动脉瓣置换术创伤小,出血和输血少并发症少术后恢复快,安全可靠,效果确切,值得临床推广。Objective To summarize the clinical experience of minimally invasive aortic valve replacement （AVR） through right parasternal longitudinal small incision for patients with aortic valve disease, and to evaluate its safety and effect. Methods From December 2014 to March 2016, 8 patients including 5 males and 3 femals underwent minimally invasive AVR in Cardiac Surgery Center of Sichuan Provincial People＆#39;s Hospital were enrolled. The mean age was （45.12 ± 9.09） years. All patients were ventilated with a double lumen endotracheal tube after general anesthesia. Right internal jugular vein, right femoral artery and vein cannulation were used to establish cardiopulmonary bypass （CPB）. Minimally invasive AVR was performed through the 2nd to 3rd in tercostal space with a 4 to 6 centimeter right parasternal longitudinal incision. Results No patient was converted to anterior median thoracotomy. No death was found. All patients were cured and discharged from hospital. The mean CPB time, crossclamp time, operation time, postoperative ventilator support time, postoperative intensive care unit stay time and postoperative hospitalization time were （102.87 ± 29.88） minutes, （69.00 ± 20.98） minutes, （248.12 ± 69.69） minutes, （10.42 ± 3.08） hours, （17.56 ± 3.19） hours, （8.00 ± 2.87） days respectively. The mean intraoperative blood loss was （212.50 ± 84.64） milliliter. The postoperative first 24 h thoracic drainage volume was （195.46 ± 60.38） milliliter. The drainage time of thoracic drainage tube was （2.32 ± 0.55） days.Tthe mean volume of blood transfusion was （218.75 ± 247.76） milliliter. The mean length of incision was （4.92 ± 0.88） centimeter. All patients were followed up for （11.50 ± 4.37） months. During the following-up, no patient died, no perivalvular leakage and prosthetic valve dysfunction were found by ultrasound echocardiography. The heart function was improved to grade Ⅰ. Conclusions Minimally invasive AVR through peripheral vascular can b

关 键 词：主动脉瓣置换术 微创 胸骨旁小切口 疗效 

分 类 号：R654.2[医药卫生—外科学]