胸腔镜主动脉瓣和二尖瓣双瓣膜置换术的动物实验研究及临床应用

Thoracoscopic mitral and aortic valves replacement: Animal experiments and clinical application

目的探讨胸腔镜下二尖瓣和主动脉瓣双瓣膜置换术的可行性。方法实验动物组（16只犬）和临床组（1例临床病例）股动脉、股静脉插管建立体外循环。右胸壁做一个4～5cm小切口和2个1．5cm小孔，用自行设计的腔静脉阻断器阻断上下腔静脉，升主动脉插冷灌针灌注停跳液保护心肌。间断缝合人工机械二尖瓣膜和主动脉瓣膜。结果实验动物组：体外循环时间104～196min，（143．2±46，5）min；升主动脉阻闭时间58—128min，（82．4±26．1）min。术后取出心脏标本检查，人工二尖瓣及主动脉瓣，缝合确切，无松线及周围组织撕裂。临床组1例：体外循环时间157min，升主动脉阻闭时间112min；术后呼吸机辅助时间10h，术后胸腔引流液150ml，术后住院时间10d；术后随访9个月，未发现瓣周漏及其他术后并发症；心脏超声示人工瓣膜活动良好，无瓣周漏。结论胸腔镜二尖瓣和主动脉瓣双瓣膜置换术技术上可行。

Objective To investigate the feasibility of aortic and mitral valves replacement under video-assisted thoracoscope. Methods The subjects included 16 dogs （Experimental Group） and a clinical volunteer （Clinical Group）. The procedure was performed under extracorporeal circulation with femoral artery and vein intubation. An incision 4-5 cm in length and two 1.5 cm ports were made in the right chest wall. The superior and inferior vena cava were cross-clamped by a self-made clamp and the myocardium was protected by cold cardioplegic coronary perfusion. Artificial mechanical aortic and mitral valves were intermittently sutured. Results In the Experimental Group： the time of extracorporeal circulation was 104 - 196 min （ 143.2±46.5 min） and the ascending aorta cross-clamped time was 58 - 128 min （82.4±26.1 min）. Autopsy findings showed satisfactory valve suture fixation, without thread loosing or paravalvular rupture. In the Clinical Group： the time of extracorporeal circulation was 157 min, the ascending aorta cross-clamped time was 112 min, the time of mechanical ventilation was 10 h, and the drainage volume, 150 ml. The patient was discharged from hospital on the 10 postoperative day. Follow-up observations for 9 months found no paravalvular leakage or other complications. Echocardiography showed normal prosthetic valve movement. Conclusions Video-assisted thoracoscopic aortic and mitral valves replacement is technically feasible.