单操作孔全胸腔镜与传统开胸二尖瓣置换术的效果比较  

Comparison effect of thoracoscopic versus open-chest mitral valve replacement

作　　者：张辉 赵寅生 张学栋 ZHANG Hui;ZHAO Yinsheng;ZHANG Xuedong(Department of Cardiothoracic Surgery,Qinghai Province Cardiovascular and Cerebrovascular Disease Specialist Hospital,Xining,Xining 810006;Department of Clinical Laboratory,Qinghai Province Cardio vascular and Cerebrovascular Disease Specialist Hospital,Xining 810006,China)

机构地区：[1]青海省心脑血管病专科医院心胸外科,西宁810006 [2]青海省心脑血管病专科医院检验科,西宁810006

出　　处：《国际心血管病杂志》2024年第4期247-250,255,共5页International Journal of Cardiovascular Disease

摘　　要：目的:比较单操作孔全胸腔镜与传统开胸二尖瓣置换手术的效果。方法:选取2021年4月至2023年2月收治的二尖瓣病变患者97例,按手术方式分为胸腔镜组51例与开胸组46例,比较2组术中创伤及术后恢复情况、围术期甲状旁腺素(PTH)、心肌肌钙蛋白T(cTnT)水平及并发症情况。结果:腔镜组手术时长、体外循环时间、主动脉阻断时间长于开胸组,使用悬浮红细胞及血浆、切口范围小于开胸组(P<0.05);腔镜组使用呼吸机时间、重症监护病房(ICU)停留时间、引流管拔除时间、住院时间短于开胸组,引流量、术后第1 d疼痛视觉模拟评分低于开胸组(P<0.05),2组术后心脏结构与功能指标差异无统计学意义;胸腔镜组体外循环停机即刻PTH、cTnT高于开胸组,2组术后24、48 h上述指标差异无统计学意义;胸腔镜组术后并发症发生率9.80%低于开胸组28.26%,(P<0.05)。结论:单操作孔全胸腔镜二尖瓣置换术创伤小,恢复快,并发症少,疗效确切,安全性与实用性较高。Objective:To compare the effect of thoracoscopic mitral valve replacement with traditional open-chest mitral valve replacement.Methods:97 patients with mitral valve disease admitted from April 2021 to February 2023 were selected and divided into thoracoscopic group(51 cases with single operating-hole thoracoscopic surgery)and thoracotomy group(46 cases with traditional thoracotomy surgery).The intraoperative trauma and postoperative recovery,perioperative levels of parathyroid hormone(PTH),cardial troponin T(cTnT)and complications were compared between the two groups.Results:The operative time,extracorporeal circulation time and aortic occlusion time in the endoscopic group were longer than those in the thoracotomy group,and the use of suspended red blood cells and plasma and the incision range were smaller than those in the thoracotomy group(P<0.05).The time of ventilator use,intensive care unitc(ICU)stay time,drainage tube removal time and hospital stay in the endoscopic group were shorter than those in the thoracotomy group,and the drainage volume and postoperative VAS score on the 1st day were lower than those in the thoracotomy group(P<0.05).There were no significant differences in postoperative cardiac structure and function between the two groups(P>0.05).PTH and cTnT in the thoracoscopic group were higher than those in the thoracotomy group immediately after extracorporeal circulation shutdown,and there were no significant differences in the above indexes between the two groups 24 h and 48 h after surgery.The incidence of postoperative complications in thoracoscopic group(9.80%)was lower than that in thoracotomy group(28.26%).Conclusion:Thoracoscopic mitral valve replacement has the advantages of less trauma,faster recovery,fewer complications,accurate efficacy,high safety and practicability.

关 键 词：单操作孔 胸腔镜手术 开胸手术 二尖瓣置换术 围手术期 

分 类 号：R654.2[医药卫生—外科学]