完全胸腔镜技术在肺动脉瓣狭窄手术治疗中的应用  

Application of complete thoracoscopy in the surgical treatment of pulmonary valvular stenosis

作　　者：郑德志 陈亚武 石广永 赵琳 乔娜 俞世强 徐学增 ZHENG De-zhi;CHEN Ya-wu;SHI Guang-yong;ZHAO Ling;QIAO Na;YU Shi-qiang;XU Xue-zeng(The 960^(th) Hospital of the PLA Joint Logistics Support Force,Jinan 250031,China;Department of Cardiovascular Surgery,The First Affiliated Hospital,Air Force Medical University,Xi'an 710032,China)

机构地区：[1]中国人民解放军联勤保障部队第960医院心脏外科,山东省济南市250031 [2]空军军医大学第一附属医院心血管外科

出　　处：《中国心血管病研究》2021年第6期530-534,共5页Chinese Journal of Cardiovascular Research

基　　金：国家重点研发计划(2016YFC1301900,2016YFC1301902);济南军区总医院院长基金(2015MS09)。

摘　　要：目的探讨完全胸腔镜技术矫正肺动脉瓣狭窄(Pulmonary valvular stenosis,PS)的手术方法、安全性和有效性及优越性。方法分析2014年1月~2018年12月在空军军医大学第一附属医院(西京医院)行完全胸腔镜下PS松解术患者的临床资料。共计102例患者,男性52例,女性50例。体外循环下经右心房切口,利用腔镜用微创长剪刀行肺动脉瓣交界切开术。分析手术的安全性指标、手术创伤指标、术后恢复指标及远期随访结果。结果手术成功率100%。术后出现切口愈合不良2例(1.96%)。术后无二次开胸止血及高度房室传导阻滞病例。胸部切口长3.5~6.1(4.2±0.5)cm;体外循环时间为45~113(69.8±19.6)min;术中主动脉阻断时间32~78(49.7±14.6)min;术后呼吸机辅助时间为5~77(17.3±9.2)h;ICU驻留时间为21~143(42.5±17.9)h;术后住院时间为5~15(6.5±1.5)d。术后1年肺动脉瓣跨瓣压差(pressure gradient,PG)为16~36(25.8±7.4)mmHg(1 mmHg=0.133kPa)。出现轻度肺动脉瓣关闭不全者15例(14.71%),中度肺动脉瓣关闭不全者3例(2.94%)。结论完全胸腔镜下行PS松解术,手术安全有效,术后并发症少,大大扩展了微创心脏手术的适应证范围,在微创、快速康复及美容等方面优势突出,值得大力推广。Objective To explore the complete thoracoscopy for pulmonary valvular stenosis(PS) operation method and the safety, effectiveness and the advantages of the operation. Method The clinical data of patients who underwent pulmonary valvular junction incision by complete thoracoscopic in Xijing Hospital from 2014 to 2018 were analyzed. There were 102 patients, 52 males and 50 females. Under cardiopulmonary bypass,through the right atrial incision, thoracoscopic scissors were used to cut pulmonary valvar junction. The safety indexes, surgical trauma indexes, postoperative recovery indexes and long-term follow-up results of this operation were evaluated. Result The success rate of operation was 100%.There were 2 cases(1.96%) with poor incision healing, no secondary thoracotomy for the hemostasis and severe atrioventricular block after the operation. The total length of thoracic incision was 5.3~8.3(7.1±1.1) cm;the duration of CPB was 45~113(69.8±19.6)min;the duration of aortic cross-clamp was 32~78(46.7±14.6)min;the duration of postoperative hospitalization was 5~15(6.5±1.5) d. One year after operation, the pressure gradient of pulmonary valve was 16~36(25.83±7.45) mmHg(1 mmHg=0.133 kPa);15 cases(14.71%) with mild pulmonary valvular insufficiency and 3 cases(2.94%) with moderate pulmonary valvular insufficiency. Conclusion Complete thoracoscopic surgery for PS is safe and effective, with fewer postoperative complications. It greatly expands the indications of pulmonary valvular stenosis. It has outstanding advantages in minimally invasion, rapid rehabilitation and cosmetology, which is worth promoting.

关 键 词：完全胸腔镜 肺动脉瓣狭窄 手术治疗 

分 类 号：R654.2[医药卫生—外科学]