右胸骨旁横切口和胸骨上段切口行微创二尖瓣及主动脉瓣双瓣置换的临床对比研究  

The analysis of anterolateral minithoracotomy versus partial upper hemisternotomy in minimally invasive dual mitral and aortic valve replacement

作　　者：郭颖[1] 熊点 刘贤丰 杨晔 陈胜家 魏来 Guo Ying;Xiong Dian;Liu Xianfeng;Yang Ye;Cheng Shengjia;Wei Lai(Department of Cardiothoracic Surgery,Jiujiang First People's Hospital,Jiujiang 332000,China;Department of Cardiothoracic Surgery,Shanghai Xuhui District Central Hospital,Shanghai 200031,China;epartment of Cardiac Surgery,the Affiliated Zhongshan Hospital of Fudan University,Shanghai 200032,China)

机构地区：[1]九江市第一人民医院胸外科,332000 [2]徐汇区中心医院胸外科,上海200030 [3]复旦大学附属中山医院心外科,上海200030

出　　处：《中华胸心血管外科杂志》2019年第9期530-533,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的比较右胸骨旁横切口和胸骨上段切口行微创二尖瓣及主动脉瓣双瓣置换术的手术效果.方法回顾性分析2009年7月至2018年3月复旦大学附属中山医院心脏外科完成的30例微创二尖瓣及主动脉瓣双瓣置换术患者的临床资料,男10例,女20例,年龄15~65岁,平均(45.67±12.25)岁.根据手术入路分为右胸骨旁横切口组(右胸组)8例、胸骨上段切口组(胸骨组)22例,应用SPSS 23.0软件对两组患者的性别、年龄、术前左心室射血分数、心功能、围手术期并发症、手术时间、体外循环时间、主动脉阻断时间、ICU住院时间和手术后住院时间进行分析.结果两组均顺利完成微创双瓣置换手术,无中转正中开胸手术者.右胸组主动脉阻断[(109.00±27.80)min对(81.23±14.10)min,P=0.026]、体外循环[(152.13±27.15)min对(129.55±26.36)min,P=0.049]、手术时间[(4.81±0.77)h对(4.15±0.44)h,P=0.006]均长于胸骨上段切口组.右胸组ICU和手术后住院时间与胸骨组相比偏短[(24.63±11.55)h对(30.55±13.21)h;(5.50±0.93)天对(6.59±3.88)天],但差异无统计学意义(P=0.273;P=0.442).结论两种入路微创手术均安全、有效,右胸骨旁入路美容效果更好,住院时间更短,但手术时间、体外循环和主动脉阻断时间更长,对术者的要求更高.胸骨上段入路不改变术者习惯更适合拟开展微创双瓣置换的心脏中心.Objective To compare the results of invasive dual mitral and aortic valve replacement(DVR) through anterolateral minithoracotomy(RT) and partial upper hemistemotomy(PS) approaches. Methods This was a retrospective, observational, cohort study of collected data on 30 patients undergoing dual mitral and aortic valve replacement between July 2009 and March 2018 at Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University. There were 10 male and 20 female patients, aging from 15 to 65 years with a mean age of(45.67±12.25) years. Of these, 8 were performed through right RT and 22 through PS. SPSS 23.0 was used to analysis gender, age, left ventricle ejection fraction, New York Heart Association class, perioperative complications, total operative duration, cardiopulmonary bypass duration, aortic cross clamp time, ICU monitoring time and postoperative hospital stay of the two groups. Results Both groups successfully completed minimally invasive double-valve replacement surgery, without middle-opening thoracic surgery. Compared with PS group, patients in the RT group had longer aortic cross clamp time[(109.00±27.80)min vs.(81.23±14.10)min, P=0.026], cardiopulmonary bypass duration[(152.13±27.15)min vs.(129.55±26.36)min, P=0.049]and total operative duration[(4.81±0.77)h vs.(4.15±0.44)h, P=0.006]. In addition, the ICU monitoring time and postoperative hospital stay of patients in RT group were shorter than PS group[(24.63±11.55)h vs.(30.55±13.21)h;(5.50±0.93)day vs.(6.59±3.88)day] but there were no statistically significant(P=0.273;P=0.442). Conclusion Minimally invasive dual mitral and aortic valve replacement via RT and PS are both safe and effective. The incision of RT group is more concealed than the PS group as well as retaining sternal integrity. However, the total operative duration, cardiopulmonary bypass duration and aortic cross clamp time were longer than PS group and the requirements of the surgeon are higher. The PS group has a shorter operation time and does not change the habit of

关 键 词：双瓣置换术 微创 右胸骨旁横切口 胸骨上段切口 

分 类 号：R654.2[医药卫生—外科学]