全胸腔镜经主动脉切口行改良Morrow术的可行性  

The Feasibility of Modified Morrow Procedure by Total Thoracoscope Through Aortic Incision

作　　者：叶永火 窦志[1] 谢灯 陈远翔[1] 谢琦[1] YE Yonghuo;DOU Zhi;XIE Deng;CHEN Yuanxiang;XIE Qi(Department of Thoracic Surgery,Fujian Provincial Hospital,Provincial Clinic College of Fujian Medical University,Fuzhou 350001,China)

机构地区：[1]福建医科大学省立临床医学院,福建省立医院心血管外科,福州350001

出　　处：《福建医科大学学报》2024年第1期57-60,共4页Journal of Fujian Medical University

摘　　要：目的探索全胸腔镜经主动脉切口行改良Morrow术的可行性及早期效果。方法收集梗阻性肥厚型心肌病(HCM)患者13例,男性9例,女性4例,年龄(59.3±13.3)岁(30~77岁),术前室间隔厚度为(1.83±0.21)mm、左心室流出道峰值压差(LVOTGP)为(76.90±27.61)mmHg(1 mmHg=0.133 kPa),收缩期前向运动(SAM)征均阳性。患者均接受全胸腔镜下经主动脉切口行改良Morrow术,同期行二尖瓣二孔成形术3例。结果全组手术成功,无中转开胸,术中主动脉阻断时间(93.00±18.68)min,体外循环时间(137.70±20.49)min,术后气管插管时间(10.70±4.30)h。术后室间隔厚度为(1.18±0.26)mm、LVOTGP为(13.46±9.46)mmHg,均较术前降低,差别有统计学意义(P<0.001)。术后二尖瓣均为轻微反流,无中度以上反流,SAM征消失。随访3~12个月,临床症状改善,患者无死亡,无室间隔穿孔、左心室流出道残留梗阻和Ⅲ度房室传导阻滞。结论全胸腔镜入路经主动脉切口可更好地暴露梗阻的室间隔组织,保留胸廓的完整性,避免损伤二尖瓣前叶,早期效果良好,是一种良好的手术入路方式。Objective To explore the feasibility and early results of modified Morrow procedure through aortic incision with total thoracoscope.Method The clinical data of 13 patients with obstructive hypertrophic cardiomyopathy(HCM)who underwent modified Morrow procedure were retrospectively analyzed;there were 9 males and 4 females,aged(59.3±13.3)years(30-77 years),with apreoperative interventricular septal thickness of(1.83±0.21)mm and a left ventricular outflow tract peak pressure difference(LVOTGP)of(76.90±27.61)mmHg,all of whom had positive SAM signs.All patients underwent modified Morrow procedure through an aortic incision under thoracoscopy,and 3 cases underwent mitral valve two-port reconstruction during the same period.Result The surgery was successful in all groups,with no conversion to thoracotomy.The intraoperative aortic occlusion time was(93.00±18.68)minutes,the extracorporeal circulation time was(137.70±20.49)minutes,and the postoperative endotracheal intubation time was(10.70±4.30)hours.The postoperative interventricular septal thickness was(1.18±0.26)mm,and the LVOTGP was(13.46±9.46)mmHg,both of which were lower than the preoperative ones(P<0.001).The postoperative mitral valves all had mild regurgitation,no more than moderate regurgitation,and systolic forward motion disappeared.Follow-up of 3-12 months showed improvement in clinical symptoms and no patient died.There was no ventricular septal perforation,residual obstruction of the left ventricular outflow tract,or third-degree atrioventricular block.Conclusion Total thoracoscopic approach through aortic incision can better expose the obstructed interventricular septal tissue,preserve thoracic integrity,and avoid damage to the anterior mitral lobe.It provides good early results,and is a good surgical approach.

关 键 词：胸腔镜 改良Morrow手术 梗阻性肥厚型心肌病 

分 类 号：R654.2[医药卫生—外科学]