单孔腋下小切口手术治疗二尖瓣病变合并功能性三尖瓣关闭不全疗效观察  

Efficacy of single-port axillary small incision in treatment of mitral valve disease complicated with functional tricuspid regurgitation

作　　者：白和平[1] 李勇新[2] BAI Heping;LI Yongxin(Department of Cardiothoracic Surgery,Yulin No.2 Hospital,Yulin 719000,China)

机构地区：[1]榆林市第二医院胸心外科,陕西榆林719000 [2]西安交通大学第一附属医院,陕西西安710061

出　　处：《陕西医学杂志》2022年第12期1552-1556,共5页Shaanxi Medical Journal

基　　金：陕西省榆林市科技计划项目(YF-2020-056)。

摘　　要：目的:观察单孔腋下小切口手术治疗二尖瓣病变合并功能性三尖瓣关闭不全(FTR)的疗效。方法:选择二尖瓣病变合并FTR患者91例,根据手术方式不同分为微创组(45例)和传统组(46例)。两组均行二尖瓣置换术(MVR)联合三尖瓣成形术(TVP)。微创组采用单孔腋下小切口入路,传统组采用常规正中开胸入路。比较两组手术指标、术后情况、应激反应指标以及并发症发生率。结果:微创组体外循环时间和主动脉阻断时间高于传统组(均P<0.05)。微创组总住院时间、术后住院时间、机械通气时间、术后ICU停留时间、红细胞输注量、第1~3天引流量低于传统组(均P<0.05)。术后1 d,微创组前列腺素E 2、皮质醇、醛固酮水平低于传统组(均P<0.05)。两组急性肾损伤、二次开胸止血、切口感染、Ⅲ度传导阻滞发生率比较差异无统计学意义(均P>0.05)。结论:单孔腋下小切口行微创MVR和TVP治疗二尖瓣病变合并FTR疗效优于传统手术。Objective:To observe the efficacy of single-port axillary small incision surgery in the treatment of mitral valve disease complicated with functional tricuspid regurgitation(FTR).Methods:A total of 91 patients with mitral valve disease complicated with FTRwere collected and divided into minimally invasive group(45 cases)and traditional group(46 cases)according to different surgical methods.Both groups underwent mitral valve replacement(MVR)combined with tricuspid valvulo plasty(TVP).The minimally invasive group used a single-port axillary small incision approach,and the traditional group used a conventional median thoracotomy approach.The surgical indicators,postoperative conditions,stress response indicators and complication rates were compared between the two groups.Results:The cardiopulmonary bypass time and aortic occlusion time in the minimally invasive group were higheRthan those in the traditional group(all P<0.05).The total hospital stay,postoperative hospital stay,mechanical ventilation time,postoperative ICU stay time,red blood cell transfusion volume,and drainage volume on the 1st to 3rd day in the minimally invasive group were loweRthan those in the traditional group(all P<0.05).On the postoperative day 1,the levels of prostaglandin E 2,cortisol and aldosterone in the minimally invasive group were loweRthan those in the traditional group(all P<0.05).There was no significant difference in the incidence of AKI,secondary thoracotomy,wound infection,and third-degree conduction block between the two groups(all P>0.05).Conclusion:Minimally invasive MVRand TVP with single-port axillary small incision are superioRto traditional surgery in the treatment of mitral valve disease with FTR.

关 键 词：二尖瓣病变 功能性三尖瓣关闭不全 单孔腋下小切口 二尖瓣置换术 三尖瓣成形术 

分 类 号：R542.51[医药卫生—心血管疾病]