经右胸第3肋间小切口与胸骨正中切口行单纯主动脉瓣置换术疗效比较的回顾性队列研究  

Efficacy of aortic valve replacement through the right third intercostal small incision versus median sternal incision:A retrospective cohort study

作　　者：颜磊 陈庆伟 陈国庆[1] 高阳[2] 乔衍礼[1] YAN Lei;CHEN Qingwei;CHEN Guoqing;GAO Yang;QIAO Yanli(Department of Cardiovascular Surgery,Affiliated Hospital of Jining Medical College,Jining,272029,Shandong,P.R.China;Department of Cardiac Intensive Care Unit,Affiliated Hospital of Jining Medical College,Jining,272029,Shandong,P.R.China)

机构地区：[1]济宁医学院附属医院心脏外科,山东济宁272029 [2]济宁医学院附属医院心脏重症监护室,山东济宁272029

出　　处：《中国胸心血管外科临床杂志》2023年第4期540-545,共6页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的对比分析经右胸第3肋间小切口与胸骨正中切口行单纯主动脉瓣置换术的安全性及有效性。方法回顾性纳入济宁医学院附属医院心脏外科2013年6月—2020年5月因主动脉瓣病变行首次单纯主动脉瓣置换术的123例患者。经右胸第3肋间小切口行主动脉瓣置换术患者为微创组,经胸骨正中切口行主动脉瓣置换术患者为常规组。比较两组患者的临床结果。结果微创组共40例患者,其中男29例(72.5%)、女11例(27.5%),年龄(54.60±9.98)岁,体重指数(body mass index,BMI)为(23.16±2.48)kg/m^(2);常规组共83例患者,其中男56例(67.5%)、女27例(32.5%),年龄(58.77±9.71)岁,BMI(24.13±3.13)kg/m^(2)。微创组主动脉阻断时间、体外循环时间和手术时间较常规组长,气管插管时间较常规组短(P<0.05);微创组术中出血量、术后24 h引流量和住院总费用较常规组少(P<0.05);两组ICU停留时间、术后住院时间和总住院时间差异无统计学意义(P>0.05)。结论经右胸第3肋间小切口行主动脉瓣置换术安全可靠,术中出血量少,术后24 h引流量少,创伤小,具有一定优势。Objective To analyze the safety and effectiveness of minimally invasive small incision through the right third intercostal and standard aortic valve replacement.Methods The clinical data of 123 patients with the first simple aortic valve replacement in our hospital from June 2013 to May 2020 were retrospectively analyzed.The patients receiving aortic valve replacement through the right third intercostal small incision were allocated to a minimally invasive group,and patients receiving aortic valve replacement through the median sternal incision were allocated to a common group.The clinical outcomes of the two groups were compared.Results There were 40 patients in the minimally invasive group,including 11(27.5%)females and 29(72.5%)males,aged 54.60±9.98 years with the body mass index(BMI)of 23.16±2.48 kg/m^(2).There were 83 patients in the common group,including 27(32.5%)females,56(67.5%)males,aged 58.77±9.71 years,with the BMI of 24.13±3.13 kg/m^(2).Compared with the common group,the aortic cross-clamping time,cardiopulmonary bypass time,and operation time were longer(P<0.05),the ventilator support time was shorter(P<0.05),and the blood loss,postoperative 24 h chest drainage volume and total expense were less(P<0.05)in the minimally invasive group.The ICU stay,postoperative hospital stay,and total hospital stay were not statistically different between the two groups(P>0.05).Conclusion The aortic valve replacement through the right third intercostal small incision is safe and effective,with less blood loss,24 h chest drainage volume and invasiveness.

关 键 词：主动脉瓣置换术 右胸小切口 胸骨正中切口 周围体外循环 

分 类 号：R654.2[医药卫生—外科学]