右腋下小切口二尖瓣成形术68例

Mitral Valve Repair through a Small Right Infra-axillary Incision:Report of 68 Cases

目的探讨经右腋下小切口行二尖瓣成形术的临床效果。方法回顾性分析2003年1月～2011年12月经右腋下5～10 cm小切口行二尖瓣成形术68例的资料。二尖瓣成形方法包括瓣叶裂隙修补6例,瓣叶部分切除28例,交界成形12例,双孔成形10例,人工腱索6例,腱索缩短3例,瓣叶心包补片修补3例;68例中人工瓣环植入38例。结果 68例手术均顺利完成,无严重并发症发生,无手术死亡。术后1周复查超声心动图,二尖瓣无明显反流或仅微量反流52例,轻度反流16例。随访65例,随访时间3个月～8年,其中>3年32例,2例复发二尖瓣重度关闭不全,经胸骨正中切口行二尖瓣置换手术。其余患者二尖瓣反流均在中度以下。结论右腋下小切口二尖瓣成形术创伤小,出血少,临床效果良好,并且切口位置隐蔽,美容效果好。

Objective To retrospectively analyze and summarize the outcomes of mitral valve repair through a small right infra-axillary incision. Methods From January 2003 to December 2011 , via a small incision （5 - 10 cm） at the right infra-axillary area, we performed mitral valve repair on 68 patients. Valvuloplasty, including cleft suture （6 cases） , partial resection of the leaflet （28 cases）, commissuroplasty （12 cases）, edge-to-edge technique （10 cases）, artificial chordae （6 cases）, chordal shortening （3 cases）, repair of perforation with autologous pericardial patch （3 cases） and annuloplasty （38 cases）, were carried out. Results The procedures were completed in all the patients without causing severe complications or death. Reexamination with echocardiography in one week showed no evident or only trivial mitral regurgitation in 52 patients, and mild regurgitation in the other 16 patients. Follow- up was achieved in 65 of the patients for 3 months to 8 years （ 〉 3 years in 32 cases） , during which two patients had recurrent severe mitral valve regurgitation, and thus underwent median sternotomy for mitral valve replacement. No medium or severe mitral valve regurgitation was detected in the other patients during the follow-up. Conclusions It is minimally traumatic and effective to perform mitral valve repair through a small right infra-axillary incision. The cosmetic outcomes of the procedure is also good.