胸骨上段小切口在心脏瓣膜手术中的应用

Superior partial median sternotomy during minimal invasive valve operation

目的 分析经胸骨上段小切口（SPMS）行心脏瓣膜手术的近期临床效果.方法 2012年10月至2013年2月,由北京市海淀医院门诊收治的病例中,经SPMS完成心脏瓣膜手术20例作为小切口组,平均年龄（51±15）岁,平均体重（66±11）kg.另采用随机数字表法选择同期行常规胸骨正中切口手术的20例心脏瓣膜病例作为常规切口组,平均年龄（57±10）岁,平均体重（65±12）kg.观察2组患者的围术期数据并进行比较.结果 2组均无围手术期死亡.小切口组无术后新发房性心律失常；术后24h胸液量为（345±160）ml,较常规切口组的（436±101）ml明显减少（P =0.036）,术后红细胞用量为（1.6±1.4）U,较常规切口组的（3.2±2.7）U明显减少（P =0.029）.结论 经SPMS行心脏瓣膜手术安全可靠,创伤小,出血少,早期结果满意.

Objective To analyze the technical progress and the clinical effect of the superior partial median sternotomy（SPMS） approach of heart valve surgery.Methods From October 2012 to February 2013,20 patients undergoing heart valve surgery through a SPMS approach were selected as minimal incision group,and 20 cases underwent heart valve surgery through a conventional sternotomy was the conventional group.There were 12 male and 8 female patients in the minimal incision group,with average age of （51 ± 15） years and average weight of （66 ± 11） kg.There were 16 male and 4 female patients in the conventional group,with average age of （57 ± 10） years and average weight of （65 ± 12） kg.Total operation duration,cardiopulmonary bypass duration,aortic cross-clamping duration,intensive care unit stay,ventilation time,amount of drainage,blood transfusion volume and postoperative hospital stay were observed and compared between the two groups.Results There were no cases of in-hospital death.There was no re-exploration for postoperative bleeding,complete atrioventricular block,embolism or perivalvular leakage in both groups.All patients in the minimal incision group with preoperative sinus rhythm remained in sinus rhythm postoperatively.Chest drainage in postoperative 24 hours in the minimal incision group was significantly less than that in the conventional group[（345 ± 160） ml vs （436 ± 101） ml,P =0.036].Red blood cells transfusion volume in the minimal incision group was significantly less than that in the conventional group[（1.6 ±1.4） U vs （3.2 ±2.7） U,P=0.029].Conclusion As a safe and reliable procedure,SPMS approach can reduce the surgical injury and achieve good early outcomes with a low volume of blood transfusion.