经右胸前外侧肋间小切口行微创主动脉瓣置换术的临床效果  

Clinical effect of right anterior mini-thoracotomy approach aortic valve replacement

作　　者：吴保星 张红强 冯宇佳 赖金华 夏利民 WU Baoxing;ZHANG Hongqiang;FENG Yujia;LAI Jinhua;XIA Limin(Department of Cardiac Surgery,Xiamen Branch,Zhongshan Hospital,Fudan University,Fujian Province,Xiamen 361015,China;Department of Cardiac Surgery,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院厦门医院心外科,福建厦门361015 [2]复旦大学附属中山医院心血管外科,上海200032

出　　处：《中国当代医药》2022年第35期57-61,共5页China Modern Medicine

摘　　要：目的评估经右胸前外侧肋间小切口行微创主动脉瓣置换术的可行性、安全性和近期疗效。方法回顾性分析2018年8月至2022年7月在复旦大学附属中山医院厦门医院行孤立性主动脉瓣置换术的30例患者的临床资料,根据手术入路分为微创组(19例)和常规组(11例)。微创组采用右胸前外侧肋间小切口微创主动脉瓣置换术,常规组采用胸骨正中切口主动脉瓣置换术。通过观察两组患者的临床资料,比较两组患者的术中情况(体外时间、阻断时间、并行时间)、术后情况(围手术期相关指标、并发症发生情况等)及随访资料,评估经右胸前外侧小切口微创主动脉瓣置换术的可行性和安全性。结果所有患者手术均顺利完成,无二次转机,微创组患者无中转常规正中开胸。微创组的体外循环时间及升主动脉阻断时间长于常规组,差异有统计学意义(P<0.05)。微创组术后24 h引流量少于常规组,住院时间短于常规组,差异有统计学意义(P<0.05)。所有患者术后无永久起搏器植入,无二次开胸止血,无深部切口感染,无瓣周漏。微创组和常规组的术后新发房颤发生率及输血率比较,差异无统计学意义(P>0.05)。两组患者均顺利康复出院,中位随访时间12个月,所有病例均无死亡,门诊评估心功能分级(NYHA)Ⅰ~Ⅱ级。结论经右胸前外侧肋间小切口行微创主动脉瓣置换术较常规胸骨正中切口主动脉瓣置换术虽然增加了体外循环时间及主动脉阻断时间,但不增加手术风险,是创伤小、恢复快、安全有效的手术方式。Objective To evaluate the feasibility,safety,and short-term effect of right anterior mini-thoracotomy approach aortic valve replacement(RAT-AVR).Methods From August 2018 to July 2022,the clinical data of 30 patients who underwent isolated aortic valve replacement in the Xiamen Branch,Zhongshan Hospital,Fudan University were retrospectively analyzed.They were divided into the minimally invasive group(19 cases)and the conventional group(11 cases)according to the surgical approach.The patients in the minimally invasive group underwent RAT-AVR,and the patients in the conventional group underwent aortic valve replacement through the conventional full sternotomy approach.The intraoperative conditions(cardiopulmonary bypass time,aortic cross-clamping time and parallel cycle time),postoperative conditions(perioperative related indicators,the incidences of complications,etc.)and follow-up data of the two groups of patients were compared,the feasibility and safety of RAT-AVR were evaluated,according to observing the clinical data of the two groups of patients.Results All patients successfully completed the surgery,without a second turnaround,and patients in the minimally invasive group did not switch to conventional full sternotomy.The cardiopulmonary bypass time and the aortic cross-clamping time in the minimally invasive group were longer than those in the conventional group,with statistically significant differences(P<0.05).The drainage volume at 24 hours after operation in the minimally invasive group was less than that in the conventional group,and the hospitalization day in the minimally invasive group was shorter than that in the conventional group,with statistically significant differences(P<0.05).All patients had no permanent pacemaker implantation,no secondary thoracotomy for hemostasis,no deep incision infection,and no perivalvular leakage.There were no significant differences in the incidence of new atrial fibrillation and blood transfusion rate between the minimally invasive group and the conventional group(P>

关 键 词：主动脉瓣置换术 微创心脏手术 微创主动脉瓣置换术 经右胸前外侧肋间小切口 

分 类 号：R654.2[医药卫生—外科学]