胸腔镜微创三尖瓣成形治疗心脏术后孤立性三尖瓣反流的技术规范  

Technical specification for minimally invasive thoracoscopic repair of isolated tricuspid regurgitation following cardiac surgery

作　　者：中国医师协会心血管外科医师分会 黄焕雷 姜胜利[8] 董念国[9] 王春生[10] 徐学增[11] 王秋吉 李飞 魏来 林柏松[12] 张海波[13] 张林[8] 钟丽珊[2] 柴云飞 Cardiovascular Surgeon Branch of Chinese Physicians'Association;Huang Huanlei;Jiang Shengli;Dong Nianguo;Wang Chunsheng

机构地区：[1]不详 [2]南方医科大学附属广东省人民医院 [3]广东省医学科学院 [4]广东省心血管病研究所 [5]广东省华南结构性心脏病重点实验室 [6]华南理工大学医学院 [7]广东省人民医院赣州医院 [8]中国人民解放军总医院 [9]华中科技大学同济医学院附属协和医院 [10]复旦大学附属中山医院 [11]空军军医大学西京医院 [12]吉林大学中日联谊医院 [13]首都医科大学附属北京安贞医院

出　　处：《中华胸心血管外科杂志》2024年第10期577-588,共12页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：国家自然科学基金项目(82270373);广州市卫生健康委员会临床高新技术项目(FTJCZ0011);广东省基础与应用基础研究基金(2019B1515120071)。

摘　　要：心脏术后远期孤立性三尖瓣反流的发病率高, 再次手术病死率高, 是瓣膜外科最为棘手的难题之一。其发病原因、治疗方法、远期结果等一直是备受关注的主要问题。随着微创外科技术的进步和三尖瓣成形手术方法的改进, 这类患者的手术效果得到明显改善。与传统的再次正中开胸三尖瓣置换手术相比, 胸腔镜微创三尖瓣成形可显著降低手术病死率和并发症发生率。然而, 微创技术与成形技术在国内各中心的发展并不平衡, 影响了心脏术后远期孤立性三尖瓣反流的治疗效果。目前的现状促成了这一国内首部有关微创三尖瓣成形手术技术规范的制订, 本规范包含以下主要内容:心脏术后三尖瓣反流的发病率与病因、术前检查及右心功能评估、适应证与禁忌证、外科手术技术与方法、麻醉管理、体外循环处理、术后重症监护治疗等7大部分, 可以为致力于开展微创三尖瓣成形手术的心血管外科医师在技术和方法上提供指导。Isolated severe tricuspid regurgitation(TR)after cardiac surgery is one of the most difficult problems in valve surgery due to its high morbidity and mortality.The aetiology,treatment methods and long-term results of isolated severe TR have always been the main issues of concern.Surgical outcomes of these patients have improved significantly with advances in minimally invasive techniques and improvements in surgical methods to tricuspid repair.Minimally invasive thoracoscopic tricuspid repair significantly reduces operative mortality and complication rates compared to redo conventional median sternotomy tricuspid valve replacement.However,the development of minimally invasive techniques and repair techniques has been uneven across the country,which has affected the long-term outcomes of isolated TR after cardiac surgery.The present situation of domestic has prompted the development of the first technical specification for minimally invasive thoracoscopic tricuspid repair in China,which includes the following main contents:incidence and aetiology of postoperative cardiac TR,preoperative examination and assessment of right heart function,indications and contraindications,surgical techniques and methods,anaesthesia management,cardiopulmonary bypass management and postoperative intensive care,etc.The specification will provide technical and methodological guidance to cardiac surgeons involved in minimally invasive tricuspid repair.

关 键 词：三尖瓣成形 心血管外科 外科手术技术 心脏术后 手术病死率 远期结果 麻醉管理 并发症发生率 

分 类 号：R654.2[医药卫生—外科学]