经右侧小切口开胸手术治疗多瓣膜病的研究  

Long-term outcomes surgical treatment of multivalvular disease through a small right minithoracotomy:a single center study

作　　者：李光[1] 杨昭 刘硕[1] 张帅 张继超 尤斌[1] LI Guang;YANG Zhao;LIU Shuo;ZHANG Shuai;ZHANG Jichao;YOU Bin(Deparment of Cardiovascular Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心外科,100029

出　　处：《心肺血管病杂志》2022年第7期792-796,共5页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:回顾性总结经右侧小切口微创瓣膜手术技术的早期和长期结果,评估通过微创治疗多瓣膜病变的可行性。方法:本研究共纳入75例多瓣膜病患者。所有患者接受经右侧小切口开胸手术和股动静脉-颈内静脉体外循环。所有患者均同期完成二尖瓣和主动脉瓣置换手术。另有11例患者接受了三尖瓣修复术,25例患者接受了房颤消融消融术。短期结果包括:住院死亡率、胸腔引流、再手术出血、手术时间、通气时间、伤口感染、输血量和住院时间。长期结果包括:全因死亡率,心力衰竭和瓣膜并发症。结果:75例平均切口长度为(5.16±2.16)cm,平均体外循环时间为(183.8±36.7)min;主动脉阻断时间为(134.2±23.9)min;插管时间中位数为17.0(14.0,22.0)h。重症监护和术后住院时间中位数分别为20.0(18.0,25.5)h和7.0(5.0,8.0)d。其中1人死于无法控制的重症感染。47例(62.7%)患者接受输血。术后平均随访时间为49.8(22.6,79.4)个月,94.6%未发生全因死亡率,87.8%未发生瓣膜并发症,97.3%未发生心力衰竭。结论:多瓣膜病变可以通过微创技术安全、可重复地完成。Objective:This study evaluates the feasibility of a small invasive technique for multivalvular disease.The aim of the study was to summurized retrospectivelythe early and long term results of a minimally invasive valve surgical technique through a small right minithoracotomy.Methods:75 multivalvular disease patients underwent a limited access approach through a right anterior small thoracotomy and a femoralinternal jugular vein cardiopulmonary bypass system using the trans-thoracic aortic cross-clamping technique.Simultaneous mitral and aortic valve replacements were completed for all 75 patients.Concomitant procedures included 11 tricuspid valve repairs and 25 ablation.Short-term outcomes included:in-hospital mortality,chest drainage,reoperation for bleeding,duration of surgery,ventilation time,deep wound infection,packed red blood cell(pRBC)transfusion and duration of hospital stay.The long‐term outcomes included:all‐cause mortality,the incidence of heart failure eventsand complication of valvulars-cause events.Results:The mean length of the incision was(5.16±2.16)cm.The mean duration cardiopulmonary bypass and cross-clamp time was 183.8±36.7 minutes and 134.2±23.9minutes, respectively. Median intubation time was 27.1±31.9hours. The median duration of intensive care and postoperative hospital stay was 31.1±33.1 hours and( 6.3±2.2) days (range 5–13), respectively. One was died of uncontrolled sepsis. There was 47(62.7%) of patients needed blood transfusion. Mean follow-up was 49.8(22.6,79.4) months (range, 6–133 months), overall freedom from all‐cause mortality was 94.6%, freedom from valvulars-cause events was 87.8 % and freedom from heart failure events was 97.3 %, respectively. Conclusions: Minimally invasive techniques for multivalvular disease can be completed safely and reproducibly.

关 键 词：多瓣膜病 微创手术 二尖瓣置换术 主动脉瓣置换术 

分 类 号：R54[医药卫生—心血管疾病]