全胸腔镜微创修复Barlow’s病长期随访结果的回顾性队列研究  

Long-term outcomes of totally endoscopic minimally invasive mitral valve repair forBarlow’s disease: A retrospective cohort study

作　　者：钟丽珊[1,3] 黄燕莹 汪珍忠[2,3] 肖硕 李玉欣 方斗 王秋吉 张朝龙 黄焕雷 ZHONG Lishan;HUANG Yanying;WANG Zhenzhong;XIAO Shuo;LI Yuxin;FANG Dou;WANG Qiuji;ZHANG Chaolong;HUANG Huanlei(Guangdong Cardiovascular Institute,Guangdong Provincial People’s Hospital,Guangdong Academy of Medical Sciences,Guangzhou,510080,P.R.China;South China University of Technology School of Medicine,Guangzhou,510641,P.R.China;Guangdong Provincial People’s Hospital,Guangdong Academy of Medical Sciences,Southern Medical University,Guangzhou,510080,P.R.China;Southern Medical University,Guangzhou,510515,P.R.China)

机构地区：[1]广东省心血管病研究所,广东省人民医院广东省医学科学院,广州510080 [2]华南理工大学医学院,广州510641 [3]南方医科大学附属广东省人民医院广东省医学科学院,广州510080 [4]南方医科大学,广州510515

出　　处：《中国胸心血管外科临床杂志》2025年第1期114-120,共7页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：广东省省级科技计划项目(2020B1111170011);广东省基础与应用基础研究基金重点项目(2019B1515120071)。

摘　　要：目的 探讨全胸腔镜微创(totally endoscopic minimally invasive,TEMI)二尖瓣修复手术在Barlow’s病治疗中的安全性、有效性和耐久性。方法 本研究采用回顾性研究方法,连续收集2010年1月—2021年6月在广东省人民医院接受二尖瓣成形手术的Barlow’s病患者的临床资料。根据手术入路方式将患者分为正中胸骨切开术(median sternotomy,MS)组和TEMI组。结果 最终纳入196例患者,其中男133例、女63例,年龄(43.8±14.9)岁。MS组103例,TEMI组93例。全组无在院死亡病例。TEMI组人工腱索植入率高于MS组(P=0.020),但两组在其他修复技术使用率方面差异无统计学意义(P>0.05)。两组总手术时间差异无统计学意义(P=0.265),TEMI组体外循环时间(P<0.001)和主动脉阻断时间(P<0.001)长于MS组,机械通气时间(P<0.001)和术后住院时间(P<0.001)均短于MS组。两组患者围手术期并发症发生率差异无统计学意义(P=0.689)。随访率为94.2%(180/191),平均随访时间0.2~12.4(4.0±2.4)年,随访期间MS组2例患者发生非心源性死亡。全组患者3年、5年和10年总生存率分别为100.0%、99.2%、99.2%。与MS组相比,TEMI组在生存率、中度及中度以上二尖瓣反流复发率、二尖瓣再次手术率、心脑血管不良事件发生率方面差异均无统计学意义(P>0.05)。结论 在Barlow’s病的二尖瓣成形手术治疗方面,TEMI安全、可行和有效,可获得良好的远期修复效果。Objective To examine the safety,efficacy and durability of totally endoscopic minimally invasive(TEMI)mitral valve repair in Barlow’s disease(BD).Methods A retrospective study was performed on patients who underwent mitral valve repair for BD from January 2010 to June 2021 in the Guangdong Provincial People’s Hospital.The patients were divided into a MS group and a TEMI group according to the surgery approaches.A comparison of the clinical data between the two groups was conducted.Results A total of 196 patients were enrolled,including 133 males and 63 females aged(43.8±14.9)years.There were 103 patients in the MS group and 93 patients in the TEMI group.No hospital death was observed.There was a higher percentage of artificial chordae implantation in the TEMI group compared to the MS group (P=0.020), but there was no statistical difference between the two groups in the other repairtechniques (P>0.05). Although the total operation time between the two groups was not statistically different (P=0.265),the TEMI group had longer cardiopulmonary bypass time (P<0.001) and aortic clamp time (P<0.001), and shortermechanical ventilation time (P<0.001) and postoperative hospitalization time (P<0.001). No statistical difference betweenthe two groups in the adverse perioperative complications (P>0.05). The follow-up rate was 94.2% (180/191) with a meantime of 0.2-12.4 (4.0±2.4) years. Two patients in the MS group died with non-cardiac reasons during the follow-up period.The 3-year, 5-year and 10-year overall survival rates of all patients were 100.0%, 99.2%, 99.2%, respectively. Comparedwith the MS group, there was no statistical difference in the survival rate, recurrence rate of mitral regurgitation,reoperation rate of mitral valve or adverse cardiovascular and cerebrovascular events in the TEMI group (P>0.05).Conclusion TEMI approach is a safe, feasible and effective approach for BD with a satisfying long-term efficacy.

关 键 词：Barlow’s病 二尖瓣反流 全胸腔镜微创 正中胸骨切开术 二尖瓣成形 

分 类 号：R654.2[医药卫生—外科学]