右胸小切口与常规正中切口瓣膜置换术的手术效果及术后早期并发症对比  

Comparison of the surgical effect and early postoperative complications of valve replacement through right-sided minithoracotomy and conventional median sternotomy

作　　者：尹力[1] 陈文[1] 邱志兵[1] 项飞[1] YIN Li;CHEN Wen;QIU Zhi-bing;XIANG Fei(Department of Cardiothoracic Vascular Surgery,Nanjing First Hospital,Nanjing Medical University,Nanjing,Jiangsu 210006,China)

机构地区：[1]南京医科大学附属南京医院南京市第一医院心胸血管外科,江苏南京210006

出　　处：《中国临床研究》2022年第10期1396-1400,共5页Chinese Journal of Clinical Research

摘　　要：目的 比较右胸小切口与常规正中切口行单瓣膜置换手术的效果及术后早期并发症发生率。方法 回顾性选取2019年7月至2021年6月于南京市第一医院实行右胸小切口闭式体外循环心脏单瓣膜置换患者30例,选择同期施行常规正中切口心脏单瓣膜置换手术患者30例。对比两组在术中术后指标、术后并发症等方面的差异。结果 右胸小切口组和正中切口组比较,体外循环时间[(123.70±20.19)min vs(89.27±23.40)min,P<0.01]和主动脉阻断时间[(87.47±15.07)min vs(64.27±15.38)min,P<0.01]延长;ICU住院时间[21.00(19.25,41.00)h vs 39.00(22.75,52.25)h,P<0.01]缩短;机械通气时间及术后住院时间两组比较,差异无统计学意义(P>0.05)。术后早期并发症总发生率右胸小切口组低于正中切口组(46.67%vs 76.67%,P<0.05)。两组手术患者均顺利出院,无围手术期死亡。结论 实施单瓣膜置换手术,与常规正中切口相比,采用右胸小切口在患者ICU住院时间上有显著优势,且术后早期并发症总发生率更低,有较好的安全性;但延长了术中体外循环时间及主动脉阻断时间,这是未来右胸小切口手术应提升的方向。Objective To compare the surgical effect and the incidence of early postoperative complications between right-sided minithoracotomy and conventional median sternotomy in single valve replacement surgery.Methods Thirty patients were selected retrospectively,who received single-valve replacement through right-sided minithoracotomy with closed cardiopulmonary bypass(minimally invasive group) in Nanjing First Hospital from July 2019 to June 2021,and 30 patients undergoing the operation through conventional median sternotomy during the same period were served as controls.The differences in intraoperative and postoperative related indicators and postoperative complications were compared between two groups.Results Compared with those in control group,the cardiopulmonary bypass time [(123.70 ± 20.19) min vs(89.27 ± 23.40) min,P<0.05].The total incidence of early postoperative complications in minimally invasive group was significantly lower than that in control group(46.67% vs 76.67%,P<0.05).All patients were discharged successfully,and there was no perioperative death in both groups.Conclusion For the patients with single-valve replacement,the right-sided minithoracotomy has the advantage in the shorter stay in ICU,the lower incidence of early postoperative complications and the better safety compared with the conventional median sternotomy.However,it prolongs the intraoperative cardiopulmonary bypass time and aortic cross-clamp time,which should be improved in the future.

关 键 词：右胸小切口 正中切口 瓣膜置换手术 并发症 

分 类 号：R654.2[医药卫生—外科学]