双孔法全胸腔镜主动脉瓣-二尖瓣双瓣置换术的技术细节探讨及早期结果分析  

Technical exploration and early results of two-port total thoracoscopic aortic-mitral double-valve replacement

作　　者：陈波 戴小福[1] 王涛[1] 郑子赫 许政 王威 江鑫 杨泉林 Chen Bo;Dai Xiaofu;Wang Tao;Zheng Zihe;Xu Zheng;Wang Wei;Jiang Xin;Yang Quanlin(Department of Cardiovascular Surgery,Fujian Medical University Union Hospital,Fuzhou 350000,China;Department of Cardiovascular Surgery,Gaozhou People's Hospital,Maoming 525200,China;Department of Cardiovascular Surgery,Xiamen Branch,Zhongshan Hospital,Fudan University,Xiamen 361015,China)

机构地区：[1]福建医科大学附属协和医院心外科,福州350000 [2]高州市人民医院心外科,茂名525200 [3]复旦大学附属中山医院、厦门医院心外科,厦门361015

出　　处：《中华外科杂志》2024年第5期400-405,共6页Chinese Journal of Surgery

摘　　要：目的探讨全胸腔镜主动脉瓣-二尖瓣双瓣置换术的临床结果。方法本研究为回顾性病例系列研究。回顾性分析2021年11月至2022年8月在福建医科大学附属协和医院心外科接受双孔法全胸腔镜主动脉瓣-二尖瓣双瓣置换术的50例患者的临床资料。男性32例,女性18例,年龄(55.3±8.8)岁(范围:21~62岁),其中风湿性瓣膜病变36例,感染性心内膜炎14例。选择右侧腋前线和锁骨中线之间第3肋间作为主操作孔,顺利完成全胸腔镜双瓣置换术。记录患者基线资料、术中资料、手术结果和术后并发症。结果心肺转流时间为(168.2±30.9)min(范围:125~187 min),主动脉阻断时间为(118.8±16.5)min(范围:96~147 min),5例植入生物瓣,45例植入机械瓣膜。术后机械通气时间为(9.6±3.4)h(范围:5.1~14.2 h),ICU停留时间(24.8±7.3)h(范围:16.3~30.1 h),术后住院时间(6.5±1.2)d(范围:5.0~8.0 d)。4例输注红细胞,输注量(2.7±0.9)单位(范围:2~4单位),术后胸腔引流量为(222.1±56.3)ml(范围:175~289 ml)。术中及术后早期无患者死亡。1例患者因主动脉切口出血需要开胸探查止血,3例主动脉瓣位人工瓣发生轻-中度瓣周漏,无Ⅲ度房室传导阻滞及中转正中开胸手术。结论全胸腔镜双瓣置换术早期结果满意,具备一定的安全性和有效性。Objective To examine the clinical outcomes of patients undergoing total thoracoscopic aortic-mitral double-valve replacement.Methods This is a retrospective case series study.The clinical data of 50 patients who underwent double-valve replacement under a total thoracoscopic two-port approach from November 2021 to August 2022 in the Department of Cardiovascular Surgery,Fujian Medical University Union Hospital were retrospectively analyzed.There were 32 males and 18 females,with an age of(55.3±8.8)years(range:21 to 62 years).Among them,36 cases had rheumatic heart disease and 14 cases had infective endocarditis.The 3rd intercostal space between the right anterior axillary line and the midclavicular line was selected as the main operating hole,the total thoracoscopic double-valve replacement were successfully carried out.Baseline data,intraoperative information,surgical outcomes,and postoperative complications were collected for all patients.Results The cardiopulmonary bypass time was(168.2±30.9)minutes(range:125 to 187 minutes),the aortic cross-clamping time was(118.8±16.5)minutes(range:96 to 147 minutes).Five patients received bioprosthetic valves,and 45 received mechanical prosthetic valves.Postoperative mechanical ventilation lasted(9.6±3.4)hours(range:5.1 to 14.2 hours),the ICU stay was(24.8±7.3)hours(range:16.3 to 30.1 hours),and the postoperative hospital stay was(6.5±1.2)days(range:5.0 to 8.0 days).Four patients received red blood cell transfusions of(2.7±0.9)units(range:2 to 4 units),and the postoperative chest drainage volume was(222.1±56.3)ml(range:175 to 289 ml).No deaths occurred intraoperatively or in the early postoperative period.One patient required reoperation due to bleeding in the aortic incision.Three patients had mild to moderate paravalvular leakage around the prosthetic aortic valve,with no cases of third-degree atrioventricular block or conversions to median sternotomy.Conclusions The early outcomes of total thoracoscopic double valve replacement surgery are satisfactory,demonstratin

关 键 词：心脏瓣膜疾病 胸腔镜检查 外科手术 微创性 双瓣置换 心脏瓣膜假体植入 

分 类 号：R654.2[医药卫生—外科学]