胸腔镜下二尖瓣成形术治疗二尖瓣狭窄的临床研究  

Clinical study of thoracoscopic mitral valvuloplasty for mitral stenosis

作　　者：陈健超[1] 周志明[1] 杨斌[1] CHEN Jian-chao;ZHOU Zhi-ming;YANG Bin(Department of Cardiac Surgery,the 7th People's Hospital of Zhengzhou,Zhengzhou 450001,China)

机构地区：[1]郑州市第七人民医院心脏外科,河南郑州450001

出　　处：《腹腔镜外科杂志》2021年第8期618-622,共5页Journal of Laparoscopic Surgery

基　　金：河南省医学科技攻关计划项目(201403250)。

摘　　要：目的:探讨胸腔镜下二尖瓣成形术治疗二尖瓣狭窄的临床效果。方法:回顾分析2016年3月至2019年4月收治的96例二尖瓣狭窄患者的临床资料,按治疗方式分为对照组(n=47)与研究组(n=49),对照组行开胸二尖瓣成形术,研究组行胸腔镜下二尖瓣成形术。对比两组手术情况、心肌酶、脑钠肽、心房利钠肽、超声心动图及并发症发生情况。结果:研究组手术时间、体外循环时间及升主动脉阻断时间长于对照组,差异有统计学意义(P<0.05),切口范围、术中出血量、呼吸机辅助时间、重症监护室停留时间、引流管拔除时间、引流量及住院时间均少于对照组(P<0.05)。术后,两组心肌酶水平均上升,研究组低于对照组(P<0.05);两组脑钠肽、心房利钠肽水平均下降,组间差异无统计学意义(P>0.05);两组心脏指数、二尖瓣口面积均上升,左心室舒张末期内径均缩小,组间相比差异无统计学意义(P>0.05)。研究组并发症总发生率低于对照组,差异有统计学意义(P<0.05)。结论:胸腔镜下二尖瓣成形术是治疗二尖瓣狭窄安全、有效的术式,能减轻手术创伤,促进术后康复。Objective:To study the clinical effect of thoracoscopic mitral valvuloplasty for mitral stenosis.Methods:Clinical data of 96 patients with mitral stenosis from Mar.2016 to Apr.2019 were retrospectively analyzed.Patients were divided into control group(n=47)and research group(n=49)according to different treatment methods.The control group was treated with open mitral valvuloplasty,while the research group was treated with thoracoscopic mitral valvuloplasty.The operation conditions,myocardial enzyme,brain natriuretic peptide,atrial natriuretic polypeptide,echocardiogram and complications of the two groups were compared.Results:The operation time,cardiopulmonary bypass time and ascending aorta blocking time in the research group were longer than those in the control group,the differences were statistically significant(P<0.05);the incision scope,intraoperative blood loss,ventilator-assisted time,intensive care unit stay time,drainage tube extraction time,drainage volume and hospitalization time of the research group were all less than those of the control group(P<0.05).After operation,the levels of myocardial enzymes in both groups increased,and the level in the research group was lower than that in the control group(P<0.05).After the operation,the levels of brain natriuretic peptide and atrial natriuretic polypeptide in both groups decreased,the difference was not statistically significant between the 2 groups(P>0.05).After operation,the cardiac index and mitral valve area of the two groups increased,and the left ventricular end diastolic diameter decreased,there was no significant difference between the two groups(P>0.05).The total incidence of complications in the research group was lower than that in the control group,the difference was statistically significant(P<0.05).Conclusions:Thoracoscopic mitral valvuloplasty is a safe and effective surgical method for mitral stenosis,it can reduce surgical trauma and promote postoperative recovery.

关 键 词：二尖瓣狭窄 胸腔镜检查 二尖瓣成形术 

分 类 号：R654.2[医药卫生—外科学]