经食道超声心动图指导下全胸腔镜二尖瓣成形手术的新理念  

Novel concept of total thoracoscopic mitral valve repair under the guidance of transesophageal echocardiography

作　　者：赵琳 李华[2] 孟欣 石广永 陈亚武 郭春霞[4] 徐学增 Zhao Lin;Li Hua;Meng Xin;Shi Guangyong;Chen Yawu;Guo Chunxia;Xu Xuezeng(Department of Cardiovascular Surgery, Xijing Hospital, Air Force Medical University, Shaanxi Xi'an 710032, China)

机构地区：[1]空军军医大学第一附属医院心血管外科,西安710032 [2]中国人民解放军第九八六医院驻空军工程大学中心校区门诊部,西安710051 [3]空军军医大学第一附属医院超声科,西安710032 [4]中国人民解放军第九八六医院驻空军工程大学信息与导航学院门诊部,西安710054

出　　处：《中国体外循环杂志》2019年第2期84-86,120,共4页Chinese Journal of Extracorporeal Circulation

基　　金：国家重点研发计划(2016YFC1301900;2016YFC1301902)

摘　　要：目的探讨全胸腔镜经食道超声心动图(TEE)指导下二尖瓣成形手术的疗效。方法 2015年5月至2018年6月对西京医院346例二尖瓣关闭不全患者开展了TEE指导下全胸腔镜二尖瓣成形手术。男性148例,女性198例。年龄9～67(44.6±12.4)岁,体重32～89(47.4±16.5) kg。手术采用股动脉、股静脉插管建立外周心肺转流、阻闭升主动脉,冷血心脏停搏液顺行灌注行心肌保护,完全胸腔镜下行二尖瓣成形手术及相关手术。结果 346例二尖瓣成形患者中337例植入成形环,9例未植入成形环。其中非风湿类病变手术一次转机成形成功308例(94.5%),风湿类病变一次转机成形成功15例(75%)。术后TEE及出院前复查心脏超声提示二尖瓣未见明显狭窄或反流,无二尖瓣收缩期前向运动(SAM征)。253例患者获得随访,随访时间2～37(22±7)月。随访期间无死亡,二尖瓣复发中度关闭不全6例,1例患者二尖瓣成形后17个月行二次手术。结论全胸腔镜下TEE指导下二尖瓣成形手术,提高了手术精度,避免了外科医生对病变性质、范围、严重程度的误判,降低了手术难度,疗效确切,临床可积极应用。Objective To investigate the efficacy of total thoracoscopic mitral valve repair under the guidance of transesophageal echocardiography( TEE). Methods From May 2015 to June 2018,346 patients( 148 males and 198 females) with mitral valve insufficiency underwent total thoracoscopic mitral valve repair under the guidance of TEE in our hospital. The average age was 44.6±12.4 years old( 9 to 67 years old). The average body weight was 47.4± 16.5 kg( 32 to 89 kg). Mitral valve repair was performed using thoracoscopy,and cardiopulmonary bypass was established via the femoral artery and vein. The ascending aorta was clamped with long tailor-made forceps and the myocardium protection was achieved by intracoronary perfusion of cold blood cardioplegia. Results Of the346 patients with mitral valve repair,annuloplasty ring was implanted in 337 patients( 97.7%). Cardiopulmonary bypass was successfully established in 308 non-rheumatic cases( success ratio,94.5%) and 15 rheumatic cases( success ratio,75%). Mitral valve stenosis,regurgitation and systolic anterior motion( SAM) were not detected by postoperative TEE and echocardiography before hospital discharge. Two hundred and fifty-three patients were followed up for 2 to 37( 22±7) months. There was no death during postoperative follow-up. Six patients had moderate mitral regurgitation,and one patient underwent redo surgery 17 months after the operation. Conclusion Total thoracoscopic mitral valve repair under the guidance of TEE improves the precision and efficacy of the operation,avoids misjudgment about the the feature,extent and severity of the lesion,and reduces the difficulty of the surgery,which could be safely applied in clinical practice.

关 键 词：全胸腔镜 经食道心脏超声 二尖瓣关闭不全 二尖瓣成形 微创心脏手术 

分 类 号：R654.2[医药卫生—外科学]