腔镜小切口和正中切口的Barlow二尖瓣成形手术近五年预后的单中心回顾性研究  

Nearly five-year prognosis of Barlow mitral valvuloplasty with thoracoscopic and standard median sternotomy:A single center retrospective study

作　　者：彭泳卜 郭超 王怡轩 李飞 陈思 周诚[1] 苏伟[1] 董念国[1] PENG Yong-bu;GUO Chao;WANG Yi-xuan;LI Fei;CHEN Si;ZHOU Cheng;SU Wei;DONG Nian-guo(Department of Cardiovascular Surgery,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China)

机构地区：[1]华中科技大学同济医学院附属协和医院心血管外科,湖北省武汉市430022

出　　处：《中国心血管病研究》2025年第4期298-303,共6页Chinese Journal of Cardiovascular Research

基　　金：国家自然科学基金面上项目(82470423);湖北省自然科学基金面上项目(JCZRYB202500142)。

摘　　要：目的 探讨腔镜小切口(VAMT)与标准胸骨正中切口(SMS)两种二尖瓣成形手术方法,在治疗Barlow综合征的实际应用和近五年内的预后情况。方法 采用回顾性分析方法,共收录了武汉市协和医院2019年1月至2024年12月开展直视下Barlow二尖瓣成形手术108例,其中VAMT组42例,SMS组66例。分别对体外循环时间、主动脉阻断时间、合并三尖瓣成形术情况、总输血量、引流量、机械通气时间、术后ICU停留时间、术后住院时间和术后并发症进行归纳收集,并随访转归情况。结果 VAMT组和SMS组的患者均能满意有效地完成Barlow二尖瓣成形术,两组一般情况具有可比性,均未发生院内死亡、开胸止血、急性肾衰竭以及脑血管意外的术后并发症,其差异无统计学意义(P>0.05)。不过,VAMT组术后出现了1例低心排血量综合征。另外,VAMT组相对于SMS组表现出更长的体外循环时间[(149.7±41.5)min比(98.0±22.5)min,P<0.05]和主动脉阻断时间[(93.1±32.1)min比(68.0±17.8)min,P<0.05],但在机械通气时间[(5.8±3.9)h比(8.3±2.3)h,P<0.05]、ICU停留时间[(18.2±4.2)h比(30.3±3.5)h,P<0.05]、术后住院时间[(5.0±0.2)d比(8.4±0.5)d,P<0.05]、术后24 h引流量[(80.5±40.2)ml比(350±91.4)ml,P<0.05]以及总输血量方面是优于SMS组的(P<0.05)。随访VAMT组和SMS组患者术后1年的心功能分级、左心室舒张末期内径(LVEDD)[(4.4±0.8)cm比(4.3±0.8)cm,P>0.05]、射血分数[(58.0±4.0)%比(59.0±3.0)%,P>0.05]、相应瓣膜再次手术率、二尖瓣反流复发和纠正情况、二尖瓣狭窄和三尖瓣修复情况、院外病死率方面的差异均无统计学意义(P>0.05)。结论 VAMT瓣膜成形手术是应对瓣膜介入治疗挑战的强有力武器,且在较多方面优于常规正中切口手术,采用人工腱索等修复技术可取得与常规开胸同样的术后效果。Barlow病变的处理,应采用瓣环优先的修复策略,使用大成形环以及降低后瓣高度可有效避免术后二�Objective To investigate the practical application and nearly five-year prognosis of two mitral valvuloplasty surgical approaches,the video-assisted minithoracotomy(VAMT) and the standard median sternotomy(SMS),in the treatment of Barlow syndrome.Methods A total of 108 patients who underwent Barlow mitral valvuloplasty at Wuhan Union Hospital from January 2019 to December 2024 were included using retrospective analysis,including 42 cases in VAMT group,and 66 cases in SMS group.The preoperative history data,extracorporeal circulation time,aortic block time,combined tricuspid valvuloplasty cases,total blood transfusion volume,drainage volume,mechanical ventilation time,postoperative ICU stay,postoperative hospitalization time and postoperative complications were observed in both groups.Subsequently,the regression was followed up.Results The general conditions of the patients in the VAMT and SMS groups were comparable,and all of them were able to undergo Barlow mitral valvuloplasty satisfactorily.There were no postoperative complications such as in-hospital death,reopening of the chest for excessive drainage,acute renal failure and cerebrovascular accident in both groups,so the difference was not statistically significant(P>0.05).But,one case of low cardiac output syndrome was seen in the VAMT group.Furthermore,the VAMT group showed longer extracorporeal circulation time [(149.7±41.5) min vs.(98.0±22.5) min,P<0.05] and aortic obstruction time [(93.1±32.1) min vs.(68.0±17.8) min,P<0.05] than the SMS group,but was superior to the SMS group in terms of the duration of mechanical ventilation [(5.8±3.9) h vs.(8.3±2.3) h,P<0.05],ICU stay [(18.2±4.2) h vs.(30.3±3.5) h,P<0.05],postoperative hospitalization [(5.0±0.2) d vs.(8.4±0.5) d,P<0.05],postoperative drainage volume in the24-hour postoperative period [(80.5±40.2) ml vs.(350±91.4) ml,P<0.05] and total blood transfusion volume(P<0.05).In addition,the differences in cardiac function grades,left ventricular end-diastolic internal diameter(LVEDD) [(4.4 ± 0.8) c

关 键 词：腔镜小切口 正中切口 Barlow二尖瓣成形手术 

分 类 号：R654.2[医药卫生—外科学]