三维胸腔镜下二尖瓣成形术60例临床分析

Clinical experience of 60 patients underwent three-dimensional video assisted thoracoscopic mitral valvuloplasty

目的探讨三维胸腔镜下二尖瓣成形术的治疗效果。方法回顾性分析2014年3月至2016年1月60例在广东省心血管病研究所心血管外科接受三维胸腔镜下二尖瓣成形术患者的临床资料。男性37例，女性23例；年龄15-78岁，中位年龄47岁。采用的二尖瓣成形技术包括人工种植53例、瓣环成形58例、后瓣切除13例、前瓣切除2例、交界切开1例。采用电话或门诊方式对患者进行随访。患者手术前后临床资料的比较采用配对样本t检验或Wilcoxon符号秩检验。结果本组2例患者术中中转行二尖瓣置换术，无中转开胸患者。手术时间为（213±37）min，心肺转流时间（129±31）min，主动脉阻断时间（81±21）min，术后住院时间（7±3）d。全部患者均获得随访，随访时间3-25个月，随访期间无死亡病例，无出院后再次手术病例，二尖瓣关闭不全和心功能（纽约心脏病协会分级）均较术前明显改善（Z＝-6.286，P＝0.000；Z＝-6.237，P＝0.000），无新发心房颤动。结论三维胸腔镜下二尖瓣成形术的手术操作更加精细安全，在二尖瓣成形方面有着良好的应用价值。

ObjectiveTo summarize the clinical experience of 60 patients underwent three-dimensional video assisted thoracoscopic mitral valvuloplasty.MethodsSixty patients were enrolled retrospectively from March 2014 to January 2016 in Department of Cardiacvascular Surgery, Guangdong Cardiovascular Institute. They underwent three-dimensional video assisted thoracoscopic mitral valvuloplasty. There were 37 male and 23 female patients. The range of age was 15 to 78 years （the median age was 47 years）. The techniques of mitral valvuloplasty included chordae tendineae transplantation （53 patients）, annuloplasty （58 patients）, posterior leaflet resection （13 patients）, anterior leaflet resection （2 patients）, commissure resection （1 patient）. Their information from charts were collected. The follow-up time was lasting 3 to 25 months by telephone or outpatient department interview. The data was analyzed via paired t test or Wilcoxon signed-rank test.ResultsConversions to mitral valve replacement were performed for two patients. No patients underwent thoracotomy. The operation time was （213±37） minutes, cardiopulmonary bypass time was （129±31） minutes, aortic cross clamping time was （81±21） minutes. Postoperative hospital stay was （7±3） days. During follow-up period, there were no re-operation and no death. Mitral regurgitation level and New York Heart Association class were both improved （Z=-6.286, P=0.000, Z=-6.237, P=0.000）, respectively. Besides, there was also no new atrial fibrillation patients.ConclusionsNot only does three-dimensional video assisted thoracoscopic mitral valvuloplasty maintain the advantages of 2-Dimensional thoracoscopy, but also have the similar view of median thoracotomy. This technique showed promising clinical value in the future.