单中心连续1188例胸腔镜心脏瓣膜手术的早期临床结果  

Early clinical outcomes of thoracoscopic valve surgery with 1188 consecutive cases in a single center

作　　者：董士勇 张林 李东 成楠 李梁钢 申华 何潇一 姜胜利 DONG Shi-yong;ZHANG Lin;LI Dong;CHENG Nan;LI Liang-gang;SHEN Hua;HE Xiao-yi;JIANG Sheng-li(Department of Cardiovascular Surgery,the 1st Medical Centre,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]中国人民解放军总医院第一医学中心心脏大血管外科,北京市100853

出　　处：《中国心血管病研究》2025年第4期326-331,共6页Chinese Journal of Cardiovascular Research

摘　　要：目的 总结单手术组连续施行1188例胸腔镜心脏瓣膜手术的早期临床资料,探讨胸腔镜微创技术的围手术期安全性及可行性。方法 回顾性分析2017年9月至2024年12月在解放军总医院第一医学中心由单手术组连续完成的胸腔镜瓣膜手术共1188例的临床数据,包括病历记载的术前基本信息及围手术期相关信息,以期全面评估患者的临床特征。结果 本组患者男性582例(49.0%),女性606例(51%);年龄9~86岁,平均(55.6±15.5)岁,共完成胸腔镜心脏瓣膜手术1188例,其中胸腔镜二尖瓣手术(含同期合并三尖瓣手术)849例(71.5%),胸腔镜主动脉瓣手术93例(7.8%),胸腔镜单纯三尖瓣手术210例(17.7%),另含胸腔镜改良Morrow联合二尖瓣手术34例(2.9%),以及胸腔镜主动脉瓣及二尖瓣双瓣手术2例(0.2%)。本组患者中包括胸腔镜下再次开胸心脏手术261例(22.0%),其中低温室颤下再次二尖瓣手术87例,左心瓣膜术后的三尖瓣手术174例。中转开胸手术14例(1.2%),其余患者均全程在胸腔镜下完成手术。术后中位机械通气(LCOS)时间12(8~18)h,围手术期死亡11例(0.9%),新发卒中12例(1.0%),新发心房颤动(AF)25例(2.1%),因低心排需主动脉内球囊反搏(IABP)辅助共17例(1.4%),体外膜肺氧合(ECMO)辅助9例(0.8%),术后因新发肾功能不全行肾脏替代治疗23例(1.9%),呼吸功能不全延迟拔管(超过72 h)共21例(1.8%)。10例(0.8%)患者住院期间二次手术,包括开胸止血8例,再次瓣膜手术2例。结论 在较大规模心脏瓣膜中心的成熟团队,胸腔镜技术能够应用于包括二尖瓣、三尖瓣、主动脉瓣病变在内的多种瓣膜病变,手术安全有效,可重复性好,围术期临床结果满意。Objective To report our experience of 1188 consecutive cases of thoracoscopic valve surgery performed by a single team,and to evaluate perioperative safety and feasibility of the procedure.Methods From September 2017 to December 2024,1188 patients who underwent thoracoscopic valve surgery in Department of Cardiovascular Surgery,the 1st Medical Centre,Chinese PLA General Hospital by a single operation team were included in this retrospective study.The clinical data including baseline and perioperative information were collected.Results There were 582 males and 606 females enrolled,and the mean age was 55.6±15.5 years old,ranging from 9 to 86 years old.In this consecutive series of 1188 patients,849(71.5%) patients received thoracoscopic mitral valve surgery;93(7.8%) patients received thoracoscopic aortic valve surgery;210(17.7%)patients received isolated tricuspid valve surgery;34(2.9%) patients received thoracoscopic modified Morrow procedure and mitral valve surgery;2(0.2%) patients received thoracoscopic aortic valve replacement(AVR) and mitral valve repair(MVP).Redoing thoracoscopic valve surgeries were performed in 261(22.0%) patients,including mitral valve reoperation with hypothermia-induced ventricular fibrillation arrest in 87 patients and tricuspid valve operation after left-sided valve surgery in 174 patients.Conversion rate was 1.2%(14 patients),perioperative mortality was 0.9%(11 patients).Postoperative mechanical ventilation ranged 12(8-18) hours.9(0.8%) patients received extracorporeal membrane oxygenation(ECMO) implantation,and 17(1.4%) patients received intra-aortic balloon pump(IABP) implantation due to low cardiac output syndrome(LCOS).Newly developed stroke,atrial fibrillation(AF),and dialysis were observed in 12(1.0%),25(2.1%) and 23(1.9%)patients,respectively.21(1.8%) patients were extubated after 72 h postoperatively.10(0.8%) patients received reoperation during hospitalization due to bleeding(8 patients) or valvular malfunction(2 patients).Conclusion Thoracoscopic valve surgery can be perf

关 键 词：胸腔镜心脏瓣膜手术 微创心脏手术 二尖瓣成形术 

分 类 号：R654.7[医药卫生—外科学]