二尖瓣脱垂患者微创胸腔镜二尖瓣成形术332例  

Outcomes of mitral valve repair via minimally invasive approach in patients with mitral valve prolapse:332 cases

作　　者：简杰[1] 卢聪[1] 郭惠明[1] 黄焕雷[1] 谢斌[1] 刘健[1] 陈星权[1] 陈涌斌 JIAN jie LU Cong GUO Hui-ming HUANG Huan-lei XIE Bin LIU Jian CHEN Xing-quan CHEN Yong-bin(Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510100, China)

机构地区：[1]广东省心血管病研究所广东省人民医院(广东省医学科学院),广州510100

出　　处：《岭南心血管病杂志》2017年第3期298-303,共6页South China Journal of Cardiovascular Diseases

摘　　要：目的探究二尖瓣脱垂患者通过胸腔镜微创术式进行二尖瓣成形的围术期疗效。方法我们单中心回顾性地筛选了2012年1月1日至2016年9月30日于广东省人民医院进行二尖瓣成形术的二尖瓣脱垂的患者332例进行分析,其中包括对75例Barlow综合征患者进行亚组分析。采用股动静脉穿刺插管建立体外循环的方法,通过主操作孔操作,辅助孔通过胸腔镜以及Chitwood钳经胸阻闭升主动脉,心脏顺行灌注冷血停搏液保护心肌,胸腔镜辅助或全胸腔镜下进行二尖瓣成形术。结果所有二尖瓣成形患者无围术期死亡,手术中转正中开胸3例,体外循环时间(160.6±79.8)min,主动脉阻断时间(101.9±34.8)min,手术时间(243.0±62.8)min。术中出血量为(185.6±66.5)mL,69例(20.8%)患者需要术中输血;术后呼吸机辅助呼吸时间(15.8±9.3)h,重症监护病房住院时间(21.6±5.5)h,总住院时间(7.1±4.2)d。对Barlow患者的亚组分析得到类似结果。结论二尖瓣脱垂患者通过微创小切口方法进行二尖瓣成形术围术期效果满意,且在复杂二尖瓣病变(Barlow病)的患者中同样可靠。Objectives To evaluate the perioperative outcomes of mitral valve repaire via minimally invasive approachin patients with mitral valve prolapse. Methods We performed a single institutional retrospective analysis between Jan-uary 1st 2011 and September 30 th 2016 on patients with mitral valve prolapse treated with mitral valve repaire via mini-mally invasive approach（n=332）,including 75 cases with Barlow for subgroup analysis. Femoral arterio-venouscannulation was used to establish cardiopulmonary bypass（CPB）. The operation was performed through the mainport. The accessory port was performed for Chitwood aortic cross clamp,and endoscopic-assistant. A cold antegradeblood cardioplegia was applied to protect myocardium. Results There were no deaths in all cohorts during periopera-tive period. Three patients were converted into median sternotomy. CPB duration was（160.6±79.8）min,aortic cross-clamp duration was（101.9±34.8）min,Operation duration was（243.0±62.8）min. Blood loss was（185.6±66.5）mL,69（20.8%） patients needed blood transfusion. Mechanical ventilation duration was（15.8±9.3）h. Intensivecare unit（ICU）stay duration was（21.6±5.5）h,and hospital stay duration was（7.1±4.2）d. The subgroup analysisfor Barlow patients in the present study showed similar results. Conclusions Minimally invasive access for mitral valverepaire can give satisfactory perioperative outcomes,and the same advantages are found in Barlow cases.

关 键 词：二尖瓣脱垂 胸腔镜 微创 外科手术治疗 

分 类 号：R542.51[医药卫生—心血管疾病]