右胸前外侧小切口低温室颤法与标准胸骨正中切口在再次二尖瓣置换术中的短期疗效比较  

Comparison of Short-term Efficacy Between Right Mini-thoracotomy with Hy pothermic Ventricular Fibrillation and Standard Median Sternotomy in Mitral Valve Re-replacement

作　　者：刘宗涛 刘俊祥 王怡轩[1] 郭超[1] Liu Zongtao;Liu Junxiang;Wang Yixuan(Department of Cardiovascular Surgery,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China)

机构地区：[1]华中科技大学同济医学院附属协和医院心脏大血管外科,武汉430022

出　　处：《华中科技大学学报（医学版）》2023年第2期223-227,共5页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

基　　金：国家自然科学基金青年基金资助(No.82001701);湖北省自然科学基金青年基金资助(No.2022CFB644)。

摘　　要：目的探究右胸前外侧小切口(right mini-thoracotomy,RMT)低温室颤法(hypothermic ventricular fibrillation,HVF)及标准胸骨正中切口(standard median sternotomy,SMS)在再次二尖瓣置换术(mitral valve re-replacement,re-MVR)中的应用及短期疗效比较。方法采用回顾性分析法纳入从2016年6月至2021年6月于华中科技大学同济医学院附属协和医院心脏大血管外科行RMT-HVF及SMS下re-MVR的患者,共82例,其中RMT-HVF组30例,SMS组52例。比较两组患者术前病历资料,术中体外循环时间、手术时间、总输血量,术后ICU停留时间、住院时间、术后院内并发症发生率及随访结果等。结果相较于SMS组,RMT-HVF组总输血量更低(P<0.05),术后ICU停留时间(P<0.05)、机械通气时间(P<0.05)、脑血管意外发生率(P<0.05)明显降低,两组患者中期随访心血管不良事件发生率差异没有统计学意义(P>0.05)。结论右胸前外侧小切口低温室颤法行再次二尖瓣置换术安全可行,可结合胸腔镜辅助,相对于胸骨正中切口能够取得完全相同的手术效果,且部分并发症发生率低,患者术后恢复快,有望成为部分患者再次二尖瓣置换术的常规选择。Objective To explore the application of right mini-thoracotomy(RMT)with hypothermic ventricular fibrillation(HVF)and standard median sternotomy(SMS)in mitral valve re-replacement(re-MVR)and to compare their short term clinical effects.Methods A total of 82 patients who underwent re-MVR with RMT-HVF(n=30)or SMS(n=52)in W uhan Union Hospital from June 2016 to June 2021 were included in the retrospective analysis.The preoperative medical records,cardiopulmonary bypass time,operation time,total blood transfusion,ICU stay time,TNI on the first day after operation,hospital stay,postoperative complications and follow-up results were compared.Results Compared with SMS group,RMT-HVF group had lower total blood transfusion(P<0.05),ICU stay time(P<0.05),total hospital stay(P<0.05)and cerebrovascular accident(P<0.05).There was no significant difference in mid-term incidence of cardiovascular adverse events between two groups.Conclusion Mitral valve re replacement through right mini thoracotomy with hy pothermic ventricular fibrillation is safe and feasible,which can be assisted with thoracoscope.Compared with standard median sternotomy,it can achieve the same surgical effect with lower incidence of some complications and rapider recovery.It is expected to become a routine choice for mitral valve re-replacement in some patients.

关 键 词：心脏瓣膜假体植入 正中胸骨切开术 再次手术 右胸微创切口 低温室颤法 

分 类 号：R654.2[医药卫生—外科学]