电视胸腔镜辅助微创在主动脉瓣置换术中的应用

Modified vedio-assisted thoracoscopic system of two-hole-access in chest wall in aortic valve replacement

目的 探讨胸腔镜辅助下胸壁两孔法在主动脉瓣置换术中的应用.方法 19例单纯主动脉病变患者,术前经过彩色超声诊断需做主动脉瓣置换.采用股动、静脉建立体外循环,右胸骨旁线2、3或3、4肋间3～5 cm孔式切口,腋前线或腋中线5肋间1 cm做腔镜辅助孔并做术中术后引流孔.特制钳阻断升主动脉,直视分支灌注停跳液,间断缝合置换主动脉瓣.结果 全组19例围术期无死亡及严重并发症.4例行Nick＇s法扩大瓣环.主动脉阻断时间35～87 min,平均52 min.ICU时间6～62 h,平均19 h.引流量50～320 ml,平均241 ml.住院时间4～15 d,平均7.5 d.术后5 d超声检查表明无明显瓣周漏,心功能明显改善,无刀口感染及裂开.结论 改良腔镜辅助胸壁两孔法主动脉瓣置换术能较好地完成微创单纯主动脉瓣置换.术后出血少、住院时间短、疼痛轻,外观比传统切口更易于让患者接受.

Objective To explore the application of modified vedio-assisted thoracoscopy system of two- hole-access in chest wall in aortic valve replacement. Methods 19 cases diagnosed by echocardiography underwent micro invasive surgery through two holes in the left chest wall by vedio-assisted thoracoscopy system and peripheral extracorporeal circulation. Results There were no death and severe complications postoperation. In 4 cases the Nick＇s procedure was used to enlarge the valve ring. The clamping time is 35-87 min（averge 52min）. The time in ICU was 6-62 hours （average 19 h）. Blood drainage was 50-320 ml（average 241 ml）. The hospitalization time was 4-15 days （average 7.5 days）, ultrasound cardiogram 5 days after operation indicated no obvious leak around artificial valve. The heart function was improved, there was no incision infection. Conclusion It is a good way to replace the aortic valve through two-hole-access in chest wall with vedio-assisted thoracoscopic system which results less blood drainage, shorter time hospitalization and lighter pain after operation. The appearance of incision is more acceptable than classic incision.