针对二尖瓣反流经右胸小切口或常规正中开胸术行二尖瓣修复术对心肺功能的影响(英文)  

Impact on cardiopulmonary function of mitral valve repair surgery for mitral regurgitation through right mini-thoracotomy or conventional full sternotomy

作　　者：黄海涛 王飞 丁胜光 夏春秋[1] 仲崇俊[1] 于晓强 HUANG Haitao;WANG Fei;DING Shengguang;XIA Chunqiu;ZHONG Chongjun;YU Xiaoqiang(Department of Thoracic and Cardiovascular Surgery,Nantong First People’s Hospital,The Second Affiliated Hospital of Nantong University,Nantong 226001,Jiangsu,China)

机构地区：[1]南通大学附属第二医院,南通市第一人民医院胸心血管外科,江苏南通226001

出　　处：《外科研究与新技术》2022年第4期242-252,共11页Surgical Research and New Technique

摘　　要：目的 传统的正中开胸手术(CFS)被认为是治疗二尖瓣反流(MR)的最佳方法。但其手术创伤巨大。通过右侧小开胸微创(MI)二尖瓣(MV)修复MR,可以减少手术创伤;然而,其安全性和有效性尚未确定。在本研究中,比较MR患者与MI或CFS患者之间的临床结果。方法 收集同期以MR为主的96例患者的资料。51例患者接受CFS (CFS组),45例患者接受MI (MI组)。两组患者的一般资料、手术资料、术前和术后心肺参数进行对比研究。术后总生存期、再手术和复发MR,生存分析采用Kaplan-Meier法,组间比较采用log-rank检验进行分析。结果 所有患者均顺利完成手术。MI组切口长度明显缩短。与CFS组比较,MI组术中出血量、术后输血、胸腔引流量均较CFS组少。两组患者均行房颤消融。CFS组房颤消融效果较好,而MI组术后新发房颤发生率较低。MI组出现较多肺部并发症。CFS组在术后第1、2天时炎症反应较轻。术后2 d MI组炎症反应明显减轻。两组在总生存率、无再手术生存率和无复发MR生存率上无统计学差异。结论 MI治疗MR与CFS具有同样的手术效性和安全性。绝大多数MR患者都可以进行MI治疗。Objective Conventional full sternotomy(CFS) is considered the best treatment for mitral regurgitation(MR). But the surgical trauma of CFS is great. Minimal invasive(MI) mitral valve(MV) repair for MR through right mini-thoracotomy has been developed to decrease operative trauma;however, the safety and efficacy are not defined yet. In the present study, clinical outcomes were compared between patients with MR who received MI or CFS. Methods The data of 96 patients who mainly suffered from MR during the same period were collected. Among them, 51 patients received CFS(CFS group), and 45 patients received MI(MI group). Patients’ demographics, surgical data, pre-and post-operative cardiopulmonary parameters were compared between the two groups.Postoperative overall survival, reoperation, and recurrent MR survival were estimated using the Kaplan-Meier method, and comparisons between groups were performed by log-rank test. Results The procedures were successfully performed in all patients. The incision length was significantly shorter in the MI group. Compared with the CFS group, intraoperative blood loss, postoperative blood transfusion, and thoracic drainage were less in the MI group. Atrial fibrillation ablation was performed in the two groups. In the CFS group, a better result of atrial fibrillation ablation was achieved;however, a lower incidence rate of new-onset postoperative atrial fibrillation was observed in the MI group.More pulmonary complications were found in the MI group. The inflammatory response was lighter in the CFS group on post operative day(POD) 1 and 2. On postoperative day 2, the inflammatory response in the MI group reduced significantly. No statistical difference was found in overall survival, reoperation-free survival, and recurrence-free survival. Conclusion The efficacy and safety of MI for MR are the same as CFS. MI could be performed in the vast majority of patients with MR.

关 键 词：二尖瓣修复术 二尖瓣反流 微创 常规正中开胸 

分 类 号：R654.2[医药卫生—外科学]