全胸腔镜下微创二尖瓣置换术的临床研究

Clinical study of Video-assisted mitral valve replacement under to tal thoracosopy

目的探讨全胸腔镜下微创二尖瓣置换术的临床疗效。方法将风湿性二尖瓣病变67例患者随机分为全电视胸腔镜下行二尖瓣置换术(腔镜组)32例、传统正中开胸二尖瓣置换术(传统组)35例;腔镜组切口选择在胸骨右缘3或4肋间(第三孔:主要操作孔)、右腋中线3肋间(第一孔:辅助操作孔)和右腋前线6或7肋间(第二孔:胸腔镜孔),以及腹股沟处切口作股动脉、股静脉插管建立体外循环。特制的长阻闭钳阻闭升主动脉,冷血心脏停跳液顺行灌注保护心肌。而传统组采取在全麻醉体外循环下行胸部正中切口,并以主动脉及上下腔静脉插管建立体外循环行二尖瓣替换。比较两组的手术效果。结果腔镜组体外循环时间、升动脉阻断时间及术后呼吸机辅助时间与传统组比较,无显著性差异;而腔镜组胸液引流量、术后住院时间都与传统组有显著性差异。腔镜组术后4例发生并发症,32例出院时复查心脏超声示瓣膜位置、活动良好,无瓣周漏,心功能(NYHA)Ⅱ级32例。结论全胸腔镜下微创二尖瓣置换术创伤小、住院时间短、美容,具有很好的临床应用价值。

Objective To explore the clinical effects of video assisted mitral valve replacement （MVR） under total thoracosopy. Methods Sixty seven patients with rheumatic mitral were randomly divided into two groups： thoraeosopy group （video assisted MVR under thoracosopy, n=32 ） and conventional group （MVR by conventional thoracotomy, n=35）. In thoracosopy group, the incisions were made on the right chest at the third or fourth intercostals, on the right midaxillary central line at the third intercostals and front line at the sixth or seventh intercostals to introduce the thoraeoseope. Extracorporeal circulation was set up with femoral artery and vein. The aorta was cross clamped and the myocardium was protected by coronary perfusion with cold cardiopleige. In conventional group ,thoracotomy was performed under anesthesia using extracorporeal circulation set up with aortic, superior and inferior vena. The effects of surgery were compared between two groups. Results There was no significant difference in duration of extracorporeal circulation,duration of ascending arterial occlusion and duration of postoperative mechanic ventilation assistance between two groups. The volume of drainage, postoperative hospital stay were significantly different between two groups. In thoracosopy group, complications occurred in 4 cases after operation, and cardiac ultrasound examination showed good valve position and activity, no periprothetic leakage and NYHA class Ⅱ. Conclusion Video assisted MVR under total thoracosopy is of minimal invasion, short hospital stay, good cosmetic results and clinical value.