经右侧胸骨旁第3肋间小切口与传统正中开胸行二尖瓣置换的对比研究  

A comparative study of mitral valve replacement by right 3rd intercostal small incision and traditional median thoracotomy

作　　者：高阳[1] 乔衍礼[1] 陈庆伟 陈国庆[1] 颜磊 GAO Yang;QIAO Yanli;CHEN Qingwei;CHEN Guoqing;YAN Lei(Department of Cardiovascular Surgery,Affiliated Hospital of Jining Medical College,Jining,272029,Shandong,P.R.China)

机构地区：[1]济宁医学院附属医院心脏外科

出　　处：《中国胸心血管外科临床杂志》2019年第12期1204-1207,共4页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的对比研究微创右侧第3肋间小切口与常规胸骨正中切口施行单纯二尖瓣置换术的安全性及疗效。方法统计2017年2月至2019年2月,济宁医学院附属医院心脏外科完成首次单纯二尖瓣置换术103例,其中微创右侧第3肋间小切口例(微创手术组)39例,男10例、女29例,平均年龄59.51岁;常规胸骨正中切口行二尖瓣置换64例(常规手术组),男22例、女42例,平均年龄60.22岁。病变类型:二尖瓣狭窄65例,关闭不全22例,狭窄伴关闭不全16例。结果两组患者术前临床资料差异无统计学意义(P>0.05)。全组患者均顺利完成手术。术中置换二尖瓣机械瓣74例,生物瓣29例。微创手术组术中体外循环时间、主动脉阻断时间及总住院时间与常规手术组相比差异无统计学意义(P>0.05),但术后住ICU时间明显短于常规手术组。术后早期开胸探查二次止血3例,1例为微创手术组,其余2例为常规手术组。切口感染3例,均为常规手术组。全组术后早期死亡3例,均为常规手术组,2例为术后低心排血量综合征导致多器官功能衰竭,另1例为胸骨感染并发人工瓣膜心内膜炎。结论右胸第3肋间二尖瓣置换在手术的安全性上与传统二尖瓣置换无明显差异,并未增加术后并发症的发生。但是其比传统正中开胸有手术创伤小、美观、术后切口感染发生率低、减少术后疼痛等优势。Objective To compare the safety and efficacy of simple mitral valve replacement with the third intercostal incision on the right side and the conventional midsternum incision. Methods From February 2017 to February 2019, heart surgery in the Affiliated Hospital of Jining Medical College completed the first simple mitral valve replacement(MVR) operation in 103 patients, of whom 39 patients were received minimally invasive right third intercostal small incision(a minimally invasive surgery group). There were 10 males, 29 females at average age of 59.51 years. There were 64 patients with MVR via the middle section of the common sternum(a conventional surgery group),22 males and 42 females, with an average age of 60.22 years. Types of lesions: 65 patients were with mitral stenosis,22 patients with incomplete closure, 16 patients with incomplete closure. Results There was no significant difference in preoperative clinical data between the two groups(P>0.05). The entire group of patients successfully completed the operation. Surgical replacement of mitral valve mechanical valve in 74 patients and biological valve in 29 patients. There was no significant difference between the two groups in the extracardiopulmonary cycle time, aortic blockade time and total hospitalization time. In the early stage of operation, 3 patients were examined for secondary hemostasis, 1 patient was minimally invasive surgery, and the remaining 2 patients were with routine surgery. The infection of incision occurred in3 patients, all of them were in the routine operation group. All three patients died early after operation in the routine operation group: two were postoperative low cardiac volumetric syndrome leading to multiple organ failure, and the other was sternum infection accompanied by artificial valve endocarditis. Conclusion There is no significant difference between MVR through the third rib of the right chest and traditional MVR in the safety. However, it has the advantages of small trauma, beauty, low incidence of incision infection

关 键 词：二尖瓣置换术 侧开胸 正中开胸 

分 类 号：R65[医药卫生—外科学]