经右腋下小切口和胸骨正中切口二尖瓣成形术的比较

Mitral valve repairment through a minimal right vertical infra-axillary thoracotomy versus standard median sternotomy

目的:比较经右腋下小切口和胸骨正中切口行二尖瓣成形术的效果。方法:回顾性分析2002年1月至2010年11月两种切口行二尖瓣成形术的93例病例资料,右腋下小切口组36例,胸骨正中切口组57例。两组病例皆在浅低温体外循环下进行二尖瓣修复。结果:术后右腋下小切口组死亡1例(2.8%),胸骨正中切口组无死亡病例,两组远期均无死亡病例。右腋下小切口体外循环建立时间明显比胸骨正中切口组长(P<0.05);右腋下小切口组术后24 h引流量、输血量均比胸骨正中切口组少(P均<0.05);机械通气时间右腋下小切口组也比胸骨正中切口组短(P<0.05)。两组主动脉阻断时间、转流时间、总手术时间比较差异无统计学意义。结论:右腋下小切口行二尖瓣成形术具有良好的美观和临床效果,其微创和美观的优势给二尖瓣成形术提供了另一选择。

Objective： To compare the fight vertical infra-axillary thoracotomy for mitral valve repair- ment with standard median sternotomy. Methods： A total of 93 patients, divided into a right vertical infra- axillary thoracotomy group and a standard median sternotomy group, who underwent mitral valvuloplasty from January 2002 to November 2010 were analyzed retrospectively. Results： Hospital mortality was 1 of 36 （2.8%） patients in the right vertical infra-axillary thoracotomy group and none in the standard median ster- notomy group. There was no late death in either group. The time to establish cardiopulmonary bypass was longer in the fight vertical infra-axillary thoracotomy group （ P 〈 0.05 ）. The fight vertical infra-axillary tho- racotomy group had less chest drainage during the postoperative 24 hours than the standard median sternoto- my group and required less blood transfusion （ P 〈 0.05 ）. Postoperative mechanical ventilation time was al- so less in the fight vertical infra-axillary thoracotomy group （ P 〈 0.05 ）. There were no statistical differ- ences in aortic cross-clamp time, cardiopulmonary bypass time, and total operation time between the two groups. Conclusion： The right vertical infra-axillary thoracotomy can be performed with favorable cosmetic and clinical results. It provides a good alternative to standard median sternotomy for mitral valve repair- ment.