全胸腔镜下loop-in-loop腱索重建加二尖瓣成形环植入术矫治二尖瓣脱垂患者的临床效果  

Clinical effect of loop-in-loop technique and annuloplasty ring for the treatment of mitral valve prolapse under total thoracoscopy

作　　者：王石雄[1] 高秉仁[1] 李宁荫[2] 王炜[1] 王玮璠[1] 马麒[1] 贺逢孝 薛羽[1] 柳德斌[1] WANG Shixiong;GAO Binren;LI Ningyin;WANG Wei;WANG Weifan;MA Qi;HE Fengxiao;XUE Yu;LIU Debin(Department of Cardiavascular Surgery, The Second Hospital, Lanzhou University, Lanzhou, 730030, P.R.China;Department of Cardiology, The Second Hospital, Lanzhou University,Lanzhou,730030,P.R.China)

机构地区：[1]兰州大学第二医院心外科,兰州730030 [2]兰州大学第二医院心内科,兰州730030

出　　处：《中国胸心血管外科临床杂志》2019年第8期759-765,共7页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：兰州大学第二医院“萃英科技创新”计划临床拔尖项目(CY2017-BJ01);兰州大学第二医院人才引进项目(ynyjrckyzx2015-3-10)

摘　　要：目的总结与分析全胸腔镜下loop-in-loop技术腱索重建加二尖瓣成形环植入术治疗二尖瓣脱垂患者的临床治疗效果。方法纳入我院心脏中心自2012年5月至2017年5月收治的21例二尖瓣瓣叶脱垂患者,其中男12例、女9例,年龄(50.90±9.66)岁,体重(64.81±11.56)kg。在全胸腔镜下右房-房间隔切口入路,行loopin-loop人工腱索重建加二尖瓣成形环植入术,术中行打水试验与经食管超声心动图(TEE)评估成形效果。收集术后1周、出院前及出院后进行随访的心脏彩色超声心动图、胸部X线片结果。结果全组手术均顺利、无再次成形或瓣膜置换、无中转开胸、无恶性心律失常、围术期死亡及伤口感染等并发症发生。其中10例同时行三尖瓣成形术,1例同时完成三尖瓣成形术+射频消融术,平均体外循环时间(255.57±37.24)min,主动脉阻断时间(162.24±19.61)min,loop数2~5(3.29±0.78)个,成形环大小28~34(31.11±1.88)mm,呼吸机辅助时间(19.43±14.68)h,住ICU时间(58.45±24.60)h,术后住院时间(12.28±3.61)d。术后复查经胸超声心动图(TTE),3例患者二尖瓣有微少量反流,术后口服华法林抗凝治疗6个月,术后1个月、3个月、6个月、12个月等定期进行随访,随访2~51个月。出院时左室舒张末期内径(LVEDD)(45.06±2.96)mm、左室舒张末期容积(108.11±17.09)mL、左房直径(LAD)(35.56±6.93)mm、心胸比率0.53±0.13,均较入院时明显缩小(P<0.05),肺动脉压为(19.22±6.38)mm Hg,较入院时降低(P<0.05),射血分数值62.33%±4.00%,较术前无明显变化(P>0.05)。随访期间LAD和LVEDD比术前均明显缩小,心功能较术前均有不同程度改善,无新发二尖瓣脱垂、反流量增加,无感染性心内膜炎、血栓栓塞及抗凝相关并发症。结论全胸腔镜下loop-in-loop人工腱索技术加二尖瓣成形环植入术矫治二尖瓣脱垂安全有效、创伤小、美容效果好、早中期效果良好,是值得推广的手术方式。但手术操作时�Objective To analyze the effect of loop-in-loop technique and annuloplasty ring for the treatment of mitral valve prolapse(MVP) under total thoracoscopy. Methods Between May 2012 and May 2017, 21 patients with MVP underwent mitral valve repair in our hospital. There were 12 males and 9 females with a mean age of 50.90±9.66 years and the mean weight of 64.81±11.56 kg. Loop-in-loop artificial chordae tendonae reconstruction and mitral annuloplasty were performed through the right atrial-atrial septal incision under total thoracoscopy. The water test and transesophageal echocardiography were performed during the operation to evaluate the effect of mitral annuloplasty. Data of echocardiography and chest radiography were collected postoperatively one week, before discharge and after discharge.Results All the operations were successful without re-valvupoplasty or valve replacement, conversion to median thoracotomy, malignant arrhythmia, perioperative death or wound infection. Among them, 10 patients underwent tricuspid valvuloplasty, 1 patient underwent tricuspid valvuloplasty plus radiofrequency ablation simultaneously. The mean cardiopulmonary bypass time was 255.57±37.24 minutes, aortic occlusion time was 162.24±19.61 minutes, the number of loop was 2–5(3.29±0.78), the size of ring was 28–34(31.11±1.88) mm, ventilator assistance time was19.43±14.68 hours, ICU time was 58.45±24.60 hours and postoperative hospital stay was 12.28±3.61 days. Transthoracic echocardiography was re-examined postoperatively. Mild-mitral regurgitation was found in 3 patients. Warfarin anticoagulant therapy was given orally for 6 months postoperatively. The patients were followed up regularly for2–51 months at 1, 3, 6 and 12 months postoperatively. Left ventricular end-diastolic diameter(LVEDD) was 45.06±2.96 mm, left ventricular end-diastolic volume 108.11±17.09 mL, left atrial diameter(LAD) 35.56±6.93 mm and cardiothoracic ratio 0.53±0.13 at discharge which were significantly smaller than those at admission(P<0.05). Pulmo

关 键 词：全胸腔镜 二尖瓣脱垂 人工腱索 二尖瓣修复 微创手术 

分 类 号：R654.2[医药卫生—外科学]