胸骨正中小切口与肋间侧切口瓣膜手术围术期的对比分析  

Perioperative comparison between partial median sternotomy and minithoracotomy valve surgery

作　　者：田白羽 韩杰[1] 焦玉清[1] 孟旭[1] TIAN Baiyu;HAN Jie;JIAO Yuqing;MENG Xu(Department Of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University , Beijing Institute Of Hearty Lung And Blood Vessel Diseases , Beijing 100029, China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心脏外科九病房

出　　处：《心肺血管病杂志》2019年第4期387-390,共4页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:比较胸骨正中小切口与肋间侧切口瓣膜手术患者围术期的差异。方法:选取2016 年1月至2018年8月,本中心行小切口瓣膜手术的患者。其中胸骨正中小切口患者共36例,平均年龄(45. 86±14. 83)岁,男性21例(58. 3%),主动脉瓣21例,二尖瓣15例。肋间侧切口患者54例,平均年龄(56. 77±14. 83)岁,男性31例(57. 4%),主动脉瓣30,二尖瓣24例。采用倾向性评分匹配出36对患者。结果:住院期1例患者侧切口主动脉瓣手术因主动脉根部出血死亡,但两组患者住院期间并发症发生率及死亡率差异无统计学意义。正中小切口组患者在手术阻断时间、体外循环时间、呼吸机使用时间、ICU时间显著短于侧切口组患者。术后住院时间及输血量无明显差异。结论:与肋间侧切口微创瓣膜手术相比,正中胸骨小切口患者有更好的受益,外科医生更容易掌握。Objective: To compare the clinical differences between minimally invasive valve surgery via partial median sternotomy and right mini thoracotomy. Methods: Patients who underwent minimally invasive valve surgery from January 2016 to August 2018 in Beijing Heart Surgery Center Of Valvular Diseases were re-cruited. 36 patients underwent partial median sternotomy procedure, 21 with aortic valve surgery and 15 with mitral valve surgery. There were 21 males and 15 females. The mean age was (45. 86± 14. 83) years. 54 pa-rents undement right minithoracotomy procedure , 30 with aortic valve surgery and 24 with mitral valve surgery. In this group,the mean age was(56. 77±14. 83) years. 31 patients were males. 36 paired were matched after propensity score matching. Results: One patient died because of aortic root bleeding in right minithoracotomy group in hospital. However, there were no statistical differences in morbidity and mortality between two groups in this study. Aortic crossclamp time, CPB time, mechanical ventilation time, ICU time of partial median ster- notomy group were significantly shorter than those of minithoracotomy group. There were no differences in posto- peration in-hospital time and blood transfusion between two groups. Conclusions: Comparing with right minitho-racotomy valve procedure, patients who underwent partial median sternotomy may get more benefits and it9 s easier to be acquired by cardiac surgeons.

关 键 词：微创 小切口 肋间侧切口 瓣膜 胸骨上段 胸骨下段 

分 类 号：R54[医药卫生—心血管疾病]