两种手术入路行右心房黏液瘤切除手术的临床对照研究  

Clinical feature and surgical treatment of right atrial myxomas via right mini-thoracotomy versus full median sternotomy:insights from a single-center study

作　　者：沈金强 郑佳予[1,2] 魏来 季强[1,2] 孙勇新 刘琛[1,2] 王春生 SHEN Jin-qiang;ZHENG Jia-yu;WEI Lai;JI Qiang;SUN Yong-xin;LIU Chen;WANG Chun-sheng(Department of Cardiovascular Surgery,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Shanghai Institute of Cardiovascular Disease,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院心外科,上海200032 [2]上海市心血管病研究所,上海200032

出　　处：《复旦学报（医学版）》2020年第4期546-550,共5页Fudan University Journal of Medical Sciences

基　　金：复旦大学附属中山医院青年科学基金(2018ZSQN17);上海市自然科学基金(17ZR1404800)。

摘　　要：目的对比采用右胸前外侧微创切口和胸骨正中切口行右心房黏液瘤切除手术的手术效果。方法选取2005年5月至2019年12月在复旦大学附属中山医院行手术治疗的右心房黏液瘤患者共61例,其中男性25例,女性36例,年龄19~82岁,平均(53.6±13.4)岁,根据手术切口分组,45例采用胸骨正中切口(胸骨组),16例采用右胸前外侧微创切口(微创组)。采用独立样本t检验、秩和检验、Fisher精确检验比较两组手术结果。结果两组术前资料匹配,无院内死亡患者。两组平均心肺转流时间相似,但与胸骨组相比,微创组平均手术时间、主动脉阻断时间均较短,平均机械通气时间和术后住院时间较短,引流量较少,输血率较低,差异有统计学意义。术后随访3~153个月,随访率95.6%,1例患者随访期间非心源性死亡,余患者恢复良好,随访超声心动图未见肿瘤复发。结论两种手术入路行右心房黏液瘤切除均安全有效,术后中远期复发率低,采用右胸前外侧微创切口进行手术可缩短手术时间,减少手术创伤。Objective To compare the results of surgical treatment of right atrial myomas via right mini-thoracotomy(RT)versus full median sternotomy(MS)approaches.Methods We collected data from 61 patients undergoing isolated primary right atrial myxoma resection between May 2005 and Dec2019 in the Department of Cardiovascular Surgery,Zhongshan Hospital,Fudan University.There were 25 male and 36 female patients,aging from 19 to 82 years with the mean age of(53.6±13.4)years.Of these,16 were performed through RT and 45 through MS.Outcomes of the two groups were compared used t test,rank-sum test andχ2 test or Fisher’s exact test.Results There was no in-hospital mortality.Compared with MS group,patients in RT group had longer operation time and aortic clamp time.Two patients in RT group required intraoperative conversion.Patients by way of RT was associated with a lower incidence of blood transfusions and less drainage.In addition,patients in RT group had a shorter postoperative length of stay.Conclusion Right atrial mymoxa via RT and MS are both safe and feasible.A right mini-thoracotomy approach may be utilized with better in-hospital outcomes and favorable midterm outcomes,and may be considered as a feasible alternative to the approach of full median sternotomy.

关 键 词：右心房 黏液瘤 微创 右胸前外侧切口 胸骨正中切口 

分 类 号：R654.2[医药卫生—外科学]