完全电视辅助胸腔镜与常规开胸行二尖瓣置换术的临床效果比较

Comparison of Clinical Effects Between Totally Video-assisted Thoracoscopic Surgery and Conventional Median Sternotomy for Mitral Valve Replacement

目的比较完全电视辅助胸腔镜与常规开胸行二尖瓣手术临床疗效的优缺点。方法 2012年3月～2013年10月,238例单纯二尖瓣病变分别经完全电视辅助胸腔镜（胸腔镜组,n=110）与常规开胸（常规开胸组,n=128）二尖瓣置换术。比较2组患者手术时间、升主动脉阻断时间、心肺转流时间、术后机械呼吸时间、监护室停留时间、术后住院时间和胸液引流量,术后半年复查二尖瓣返流情况。结果胸腔镜组与常规开胸组手术时间[（256.2±28.5）min vs.（251.2±30.0）min,t=1.312,P=0.191],升主动脉阻断时间[（40.0±2.7）min vs.（39.4±2.7）min,t=1.709,P=0.089],心肺转流时间[（74.2±4.1）min vs.（73.7±4.9）min,t=0.846,P=0.399]无显著性差异。胸腔镜组术后机械呼吸时间（716.4±79.1）min,明显短于常规开胸组（811.9±58.8）min（t=-10.657,P=0.000）;监护室停留时间（26.2±3.6）h,明显短于常规开胸组（29.3±4.7）h（t=-5.640,P=0.000）;术后住院时间（9.6±1.2）d,明显短于常规开胸组（10.9±2.5）d（t=-4.982,P=0.000）;胸液引流量（328.1±83.2）ml,明显少于常规开胸组（561.3±143.9）ml（t=-14.978,P=0.000）。2组患者无死亡,术后半年复查,二尖瓣均无明显返流。结论完全电视辅助胸腔镜下行二尖瓣置换术给患者造成的手术创伤明显轻于常规开胸手术。

Objective To compare clinical effects between totally video-assisted thoracoscopic surgery and conventional median sternotomy for mitral valve replacement. Methods From March 2012 to October 2013, patients with simple mitral valve disease underwent mitral valve replacement through either right chest port-access totally video-assisted thoracoscopy （thoracoscopy group, n = 110） or conventional median sternotomy （conventional group, n = 128）. The time of operation, cross-clamp ascending aorta, cardiopulmonary bypass, postoperative mechanical ventilation, intensive care unit stay, postoperative hospital stay, and volume of postoperative chest drainage were compared between the two groups. All the patients were followed after 6 months postoperatively for evaluating the condition of valve regurgitation under echocardiography. Results Between the thoraeoscopy group and the conventional group, no significant differences were found in time of operation [ （256.2 ± 28.5 ） min vs. （251.2 ± 30.0） min, t = 1.312, P=0.191], cross-clamp time of the ascending aorta [（40.0±2.7） min vs. （39.4±2.7） min, t=1.709, P=0.089], and cardiopulmonary bypass time [（74. 2 ±4. 1） rain vs. （73.7 ± 4. 9） min, t = 0. 846, P = 0. 399]. As compared to the conventional group, the thoracoscopy group had significantly shorter time of postoperative mechanical ventilation [ （716.4 ± 79.1 ） min vs. （811.9±58.8） min, t= -10.657, P=0.000], shorterlength of intensive care unit stay [（26.2±3.6） h vs. （29.3±4.7） h, t= -5.640, P=0.000], shorter length of postoperative hospital stay [（9.6 ±1.2） d vs. （10.9±2.5） d, t = -4.982, P= 0. 000 ] , and less volume of postoperative chest drainage [ （328.1 ± 83.2） ml vs. （561.3 ±143.9） ml, t = - 14. 978, P = 0. 000 ] , respectively. No death happened in the two groups. No mitral valve regurgitation was seen during follow-ups at 6 months postoperatively. Conclusion For patients undergoing mitral valve replacement, totally video-assisted thoracoscopic surgery is superior to conventional median sternotomy with respect to surgical trauma.