心脏直视术后再发三尖瓣重度关闭不全经右胸前外侧切口的治疗观察

Treatment of severe tricuspid regurgitation after open heart surgery by right-anterior lateral thoracotomy

目的探讨经右胸前外侧切口径路行三尖瓣手术治疗心脏直视术后再发三尖瓣重度关闭不全外科效果。方法 2008年3月至2015年12月,对28例心脏直视术后再发三尖瓣重度关闭不全患者经右胸前外侧切口径路行再次三尖瓣手术,观察各临床指标的变化情况。结果手术时间(152±34)min,体外循环时间(47±17)min;术中出血量(268±64)ml;术后24h胸腔引流量(530±179)ml。术后早期1例三尖瓣置换因呼吸功能不全死亡(死亡率3.6%)。另外,术后发生急性肾功能不全3例,呼吸功能不全2例,均经积极治疗后痊愈。结论对于心脏直视术后远期再发三尖瓣重度关闭不全,只要一般情况可以耐受手术,应该积极手术;而经右胸前外侧切口路径则可避免了开胸大出血,且还有手术损伤小、失血少、恢复快的优点。

Objective To investigate the effect of severe tricuspid regurgitation after open heart surgery by right-lateral thoracotomy. Methods From March 2008 to December 2015,totally 28 cases after open heart surgery in recurrent severe tricuspid regurgitation patients by right-lateral thoracotomy accepted tricuspid valve surgery. Results Operation time 101 - 215（ 152 ± 34） min,cardiopulmonary bypass time 26 - 87（ 47 ± 17） min; Intraoperative blood loss 210 -430（ 268 ± 64） ml; Postoperative 24 h thoracic drainage 300 - 750（ 530 ± 179） ml. In the early postoperative period,1Patient died of respiratory insufficiency（ death rate 3. 6%） due to valve replacement. In addition,3 cases occurred acute renal failure,2 cases occurred respiratory dysfunction,they were cured through active treatment. Conclusion After open heart surgery for long-term recurrent tricuspid regurgitation,we think should actively operation to the patients who can tolerate the operation. By right anterior-lateral thoracotomy,we can avoid open-chest hemorrhage,can significantly shorten the operation time,can reduce surgical trauma.