全腔镜微创与传统正中开胸二尖瓣成形的围术期临床结果比较  

Perioperative outcomes of mitral valvuloplasty via totally thoracoscopic approach versus traditional median sternotomy

作　　者：颜倩 周勘 柯英杰 杨亮 赖子浩 杨燕晨 郭惠明[2] 卢聪[2] 黄焕雷[2] YAN Qian;ZHOU Kan;KE Yingjie;YANG Liang;LAI Zihao;YANG Yanchen;GUO Huiming;LU Cong;HUANG Huanlei(The Second School of Clinical Medicine,Southern Medical University,Guangzhou,510515,P.R.China;Department of Cardiovascular Surgery,Guangdong Provincial People's Hospital,Guangdong Academy of Medical Sciences,Guangdong Provincial Cardiovascular Institute,Guangzhou,510080,P.R.China;Department of Cardiovascular Surgery,Guangdong Provincial People's Hospital's Nanhai Hospital,The Second People's Hospital of Nanhai District,Foshan,528000,Guangdong,P.R.China;The First School of Clinical Medicine,Southern Medical University,Guangzhou,510515,P.R.China)

机构地区：[1]南方医科大学第二临床医学院,广州510515 [2]广东省人民医院广东省医学科学院广东省心血管病研究所心外科,广州510080 [3]广东省人民医院南海医院南海区第二人民医院心外科,广东佛山528000 [4]南方医科大学第一临床医学院,广州510515

出　　处：《中国胸心血管外科临床杂志》2020年第12期1407-1412,共6页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：广东省自然科学基金项目(2016A030313799)。

摘　　要：目的比较全腔镜微创与传统正中开胸二尖瓣成形术的早期疗效及安全性。方法回顾性分析2015年1月至2018年8月于广东省人民医院接受二尖瓣成形术1221例患者的临床资料,其中男721例、女500例,平均年龄(47.2±15.1)岁。按手术方式的不同,将患者分为全腔镜微创二尖瓣成形组(试验组,n=654)和传统正中开胸二尖瓣成形组(对照组,n=567)。对比分析两组患者的临床资料、手术及围术期结果。结果两组患者术前一般资料差异无统计学意义(P>0.05)。试验组的体外循环时间和主动脉阻断时间长于对照组[(146.7±42.4)min vs.(122.7±30.6)min、(96.2±32.7)min vs.(78.3±23.8)min,P均=0.000];但试验组总手术时间短于对照组[(227.4±55.3)min vs.(238.1±56.4)min,P=0.001];两组的二次阻断发生率及转换瓣率差异无统计学意义(3.7%vs.2.6%,P=0.312;1.7%vs.1.4%,P=0.690);在输血率、呼吸道感染发生率、术后伤口愈合不良发生率等方面,试验组低于对照组(13.0%vs.24.5%、2.1%vs.18.0%、1.5%vs.5.3%,P均=0.000),且试验组的术后住院时间也短于对照组[(6.2±4.4)d vs.(11.5±8.8)d,P=0.000];两组住院费用差异无统计学意义[(95847.9±31322.0)元vs.(99673.1±47930.3)元,P=0.149]。试验组术后30 d内死亡1例,对照组术后30 d内死亡4例。出院前复查心脏彩超,试验组出现再发二尖瓣重度反流4例,对照组出现再发二尖瓣重度反流5例。结论全腔镜微创二尖瓣成形术在缩短总手术时间与术后住院时间、降低输血率、减少术后并发症方面比传统正中开胸二尖瓣成形术具有优势,可获得更好的围术期结果。Objective To compare the efficacy and safety of mitral valvuloplasty via minimally invasive approach with those of mitral valvuloplasty via traditional median sternotomy.Methods A total of 1221 patients undergoing mitral valvuloplasty from January 2015 to August 2018 in Guangdong Provincial People's Hospital were analyzed retrospectively,including 721 males and 500 females,with an average age of 47.2±15.1 years.According to the different surgical methods,they were divided into a study group(n=654),who received mitral valvuloplasty via the totally thoracoscopic approach,and a control group(n=567),who received mitral valvuloplasty via traditional median sternotomy.Clinical data,surgical results,and perioperative outcomes of the two groups were compared.Results There was no significant difference in preoperative general data between the two groups(P>0.05).Compared with the control group,the study group had longer cardiopulmonary bypass time and aortic cross-clamping time(146.7±42.4 min vs.122.7±30.6 min,96.2±32.7 min vs.78.3±23.8 min,both P=0.000),and shorter total operation time(227.4±55.3 min vs.238.1±56.4 min,P=0.001).There was no significant difference in the incidence of secondary cross-clamping and mitral valve replacement between the two groups(3.7%vs.2.6%,P=0.312;1.7%vs.1.4%,P=0.690).The blood transfusion rate and the incidence of respiratory tract infection and postoperative poor wound healing were lower(13.0%vs.24.5%,2.1%vs.18.0%,1.5%vs.5.3%,all P=0.000)and the postoperative hospital stay was shorter(6.2±4.4 d vs.11.5±8.8 d,P=0.000)in the study group.There was no significant difference in hospitalization expense between the two groups(95847.9±31322.0 yuan vs.99673.1±47930.3 yuan,P=0.149).Within 30 d after surgery,1 patient died in the study group and 4 patients died in the control group.Before discharge,there were 4 and 5 patients with severe mitral valve regurgitation in the study group and the control group,respectively.Conclusion Compared with mitral valvuloplasty via traditional median stern

关 键 词：全腔镜微创 正中开胸 二尖瓣成形 围术期结果 

分 类 号：R654.2[医药卫生—外科学]