经胸骨正中小切口行心脏瓣膜手术130例临床经验总结  

Limited sternotomy for minimally invasive valve operation

作　　者：吕锋[1] 吴清玉[1] 胡盛寿[1] 漆志涛[1] 孙寒松[1] 朱俊明[1] 潘世伟[1] 宋云虎[1] 唐跃[1] 

机构地区：[1]中国医学科学院

出　　处：《实用心脑肺血管病杂志》2004年第1期13-15,共3页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

摘　　要：目的　探讨经胸骨正中小切口行各种心脏瓣膜手术的适应证和手术方法 ,并报告 130例临床结果。　方法　 4例单纯主动脉瓣置换采用胸骨上段切口 ,其余手术均经胸骨下段切口。胸骨上段切口自胸骨上凹至第三肋间并向两侧横断胸骨 ,皮切口长度 5cm～ 7cm ;胸骨下段之皮切口自第三胸肋关节水平至剑突根部 ,长度 9cm～13cm ,自下而上纵行劈开胸骨至第二或第一肋间处向右侧横断。手术采用常规体外循环 ,共行二尖瓣置换 6 6例 ,主动脉瓣置换 2 0例 ,主动脉瓣及二尖瓣双瓣置换 32例 ,二尖瓣成形 11例 ,单纯三尖瓣成形 1例。同期行左心房血栓清除 2 2例及三尖瓣DeVega环缩 35例。　结果　无手术死亡。平均主动脉阻断、体外循环和手术时间分别为 6 3分± 2 9分、92分± 32分和 191分± 4 7分 ;平均气管插管 12小时± 5 2小时 ;平均住院 14天± 6 8天。术后胸液量平均 345ml± 197ml(5 0ml± 170 0ml) ,有 82例患者 (6 3% )未输血。　结论　正中经胸骨小切口行心脏瓣膜手术安全可靠 ,美观 (胸骨下段入路 ) ,创伤小 ,出血少 ,保留了胸廓的连续性 ,早期结果满意。Objective To review the indications,operative methods and clinical results of 130 patients underwent minimally invasive valve operation Methods From July 1998 through December 1999,130 patients underwent limited sternotomy for valve operation Of which,4 patients underwent limited upper sternotomy for aortic valve replacement(AVR) and others underwent limited lower sternotomy for various valve operation The age ranged from 8 to 62 years with a mean of 41±12 years When limited upper sternotomy was done,a midline incision from 5 to 7cm was made from the sternal notch to the third intercostal space Otherwise,a midline incision from 9 to 13cm was made from the third rib to the base of xiphoid process and transverse half sternotomy was made in the second or first intercostal space from the right border to the center of the sternum Cardiopulmonary bypass was connected through the same access in almost all the patients except 2,in whom a femoro femoral bypass was used Operations included MVR in 66 patients AVR in 20,BVR in 32,mitral valvuloplasty in 11 and isolated tricuspid valvuloplasty in 1 Additional procedures included left atrial thrombectomy in 22 patients and tricuspid valvuloplasty in 35 patients Results There was no death Aortic cross clamp time,cardiopulmonary brpass time,and operation time from skin to skin averaged 63±29?92±32 and 191±47 minutes,respectively All patients were extubated in the ICU at an average of 12±5 2 hours and discharged at an average of 14±6 8 days The median blood loss was 345±197ml(range,50 to 1 700ml) and in 82(63%) patients no homologous blood was needed Conclusion Limited sternotomy is a safe alternative method for minimally invasive valve operation which is cosmetically acceptable and permits easy access to the entire heart,the sternum is stable,the surgical trauma and postoperative blood loss are reduced,and a standard median sternotomy can be easily performed whenever necessary

关 键 词：小切口手术 手术入路 心脏瓣膜手术 适应证 手术方法 体外循环 

分 类 号：R654.2[医药卫生—外科学]