全胸腔镜二尖瓣置换术同期心脏不停跳三尖瓣成形术安全性及有效性的临床研究  

A clinical study on the safety and effectiveness of concomitant tricuspid annuloplasty during total thoracoscopic mitral valve replacement in beating heart

作　　者：韦科全 李思聪 蒋伟[1] 黄立坚 覃健 黄振旺 龙小毛[1] WEI Kequan;LI Sicong;JIANG Wei;HUANG Lijian;QIN Jian;HUANG Zhenwang;LONG Xiaomao(Department of Cardiothoracic and Vascular Surgery,the People's Hospital of Guangxi Zhuang Autonomous Region(Guangxi Academy of Medical Sciences),Nanning 530021,China)

机构地区：[1]广西壮族自治区人民医院(广西医学科学院)心胸血管外科,南宁530021

出　　处：《中国临床新医学》2024年第3期265-271,共7页CHINESE JOURNAL OF NEW CLINICAL MEDICINE

基　　金：广西卫生健康委自筹经费科研课题(编号:Z-A20220090)。

摘　　要：目的比较全胸腔镜二尖瓣置换术同期行三尖瓣人工瓣环成形术与正中开胸二尖瓣置换术同期行三尖瓣人工瓣环成形术的手术结果及短期疗效。方法回顾性分析2014年1月至2021年12月在广西壮族自治区人民医院接受二尖瓣置换术同期行三尖瓣人工瓣环成形术治疗三尖瓣反流(TR)的94例患者临床资料。68例接受正中开胸二尖瓣置换术同期心脏不停跳三尖瓣人工瓣环成形术(正中开胸组),26例接受全胸腔镜二尖瓣置换术同期心脏不停跳三尖瓣人工瓣环成形术(全胸腔镜组)。通过倾向性匹配评分(PSM)减少选择偏倚,最终得到26对病例进行分析。比较两组基本信息、手术治疗及术后随访资料,包括心脏彩超结果、手术住院相关指标等。结果全胸腔镜组手术时间、体外循环时间及阻断时间长于正中开胸组,差异有统计学意义(P<0.05)。术后1个月心脏彩超检查结果显示,两组二尖瓣收缩期血流速度、二尖瓣压差、压力减半时间(PHT)、TR面积、右心房内径(RAD)、右心室内径(RVD)以及房颤发生率比较差异无统计学意义(P>0.05)。两组术后24个月TR复发率比较差异无统计学意义(P>0.05)。术后24个月心脏彩超检查结果显示,正中开胸组二尖瓣压差显著低于全胸腔镜组(P<0.05),但两组二尖瓣收缩期血流速度、PHT、TR面积、RAD、RVD、左心室射血分数(LVEF)以及瓣周漏、房颤、肺动脉高压发生率比较差异无统计学意义(P>0.05)。结论全胸腔镜二尖瓣手术置换术同期行三尖瓣人工瓣环成形术与正中开胸二尖瓣置换术同期行三尖瓣人工瓣环成形术的疗效相当,两种手术方式均可用于临床治疗二尖瓣、三尖瓣联合瓣膜病变。Objective To compare the surgical outcomes and short-term therapeutic effects between concomitant tricuspid annuloplasty during total thoracoscopic mitral valve replacement and concomitant tricuspid annuloplasty during median sternotomy mitral valve replacement.Methods The clinical data of 94 patients with functional tricuspid regurgitation(TR)who received concomitant tricuspid annuloplasty during mitral valve replacement in the People's Hospital of Guangxi Zhuang Autonomous Region from January 2014 to December 2021 were retrospectively analyzed.Among the 94 patients,68 patients received concomitant tricuspid annuloplasty during median sternotomy mitral valve replacement in beating heart(the median sternotomy group),while 26 patients received concomitant tricuspid annuloplasty during total thoracoscopic mitral valve replacement in beating heart(the total thoracoscopic group).Propensity score matching(PSM)was used to reduce selection bias,and 26 pairs of cases were obtained finally for analysis.The basic information,surgical treatment data and postoperative follow-up data were compared between the two groups,including the results of cardiac color ultrasound and the indicators related to hospitalization due to surgery.Results The operation time,cardiopulmonary bypass time and aortic cross-clamp time in the total thoracoscopic group was longer than that in the median sternotomy group,and the difference was statistically significant(P<0.05).The results of cardiac color ultrasound examination 1 month after surgery showed that there were no significant differences in mitral systolic blood flow velocity,mitral valve pressure difference,pressure halving time(PHT),area of TR,right atrial diameter(RAD),right ventricular diameter(RVD)and the incidence of atrial fibrillation between the two groups(P>0.05).There was no significant difference in TR recurrence rate 24 months after operation between the two groups(P>0.05).The results of cardiac color ultrasound examination showed that the mitral valve pressure difference in the

关 键 词：胸腔镜 心脏不停跳 三尖瓣成形术 二尖瓣置换术 

分 类 号：R654.2[医药卫生—外科学]