Loop-in-Loop技术在胸腔镜辅助下右胸小切口二尖瓣成形术中的应用  

Results of minimally invasive, thoracoscopic-assisted mitral valve repair with Loop-in-Loop technique

作　　者：朱喜亮 程兆云[1] 王圣[1] 陈现杰 陆国庆 ZHU Xiliang;CHENG Zhaoyun;WANG Sheng;CHEN Xianjie;LU Guoqing(Department of Cardiovascular Surgery,Henan Provincial People's Hospital,Zhengzhou,450000,China)

机构地区：[1]河南省人民医院心血管外科,郑州450000

出　　处：《临床心血管病杂志》2022年第5期400-403,共4页Journal of Clinical Cardiology

基　　金：河南省医学科技攻关计划联合共建项目(No:2018020443);河南省自然科学基金项目(No:202300410405)。

摘　　要：目的:了解Loop-in-Loop技术应用于胸腔镜辅助下右胸小切口二尖瓣成形术中的临床效果。方法:回顾并总结我院2018年6月—2020年9月46例单纯二尖瓣反流患者采用Loop-in-Loop技术行胸腔镜辅助下右胸小切口二尖瓣成形术患者的临床资料,分析其术后早期疗效,应用Kaplan-Meier曲线估算总体远期免于中度及以上二尖瓣反流发生率。结果:患者均成功手术,无瓣膜置换和中转开胸,围术期未见患者死亡。术后早期并发症包括:因胸壁出血二次开胸止血2例,肺部感染3例,新发心房颤动4例。出院前复查超声提示无或微量二尖瓣反流28例(60.9%),轻度二尖瓣反流16例(34.8%),轻-中度二尖瓣反流2例(4.3%)。术后39例(84.8%)患者随访成功,平均随访时间(26.3±15.2)个月,超声提示中度二尖瓣反流2例,重度二尖瓣反流2例(其中1例行二尖瓣置换)。Kaplan-Meier曲线表明,术后12、24和36个月,免于中度以上二尖瓣关闭不全的概率为(96.2±3.5)%、(94.7±3.8)%和(93.4±4.6)%。结论:Loop-in-Loop技术安全有效,可应用于电视胸腔镜辅助下的右胸小切口二尖瓣成形手术。Objective: To understand the clinical effect of Loop-in-Loop technique in the application of thoracoscopic-assisted mitral valvuloplasty with Minimally Invasiveincision. Methods: We reviewed and summarized the clinical data of 46 patients with simple mitral regurgitation who underwent thoracoscopic-assisted right thoracic small incision mitral valvuloplasty from June 2018 to September 2020 in our hospital using the Loop-in-Loop technology, and analyzed their clinical data. The Kaplan-Meier curve was used to estimate the overall long-term recurrence rate of mitral regurgitation free from more than moderate mitral regurgitation. Results: All of the patients were successfully operated without valve replacement and conversion to median thoracotomy. No patient died during the perioperative period. Early postoperative complications included 2 cases of thoracotomy hemostasis for excessive postoperative bleeding, 3 cases of pulmonary infection, and 4 cases of new atrial fibrillation. TTE before discharge revealed no or minimal mitral regurgitation in 28 cases(60.9%), mild mitral regurgitation in 16 cases(34.8%), and mild to moderate mitral regurgitation in 2 cases(4.3%). The 39 patients(84.8%) were followed up successfully in the long-term postoperative period, with an average follow-up time of(26.3±15.2) months. TTE showed 2 cases of moderate mitral regurgitation and 2 cases of severe mitral regurgitation(1 case underwent mitral valve replacement). The Kaplan-Meier curve showed that the probability of avoiding more than moderate mitral regurgitation was(96.2±3.5)%,(94.7±3.8)% and(93.4±4.6)% at 12, 24, and 36 months after surgery. Conclusion: Loop-in-Loop technology can be safely and effectively applied to minimally invasive mitral valvuloplasty by thoracoscopic-assisted.

关 键 词：二尖瓣脱垂 二尖瓣成形 Loop-in-Loop技术 人工腱索 

分 类 号：R541.3[医药卫生—心血管疾病]