右胸小切口与标准胸骨正中切口在心脏瓣膜成形术中的比较研究

Comparative study of right minithoracotomy and standard median sternotomy in the cardiac valve repair surgery

目的探讨右胸小切口(RMT)与标准胸骨正中切口(SMS)手术方法在心脏瓣膜成形术中的应用和近期临床疗效。方法采用回顾性分析法纳入2011年5月至2014年10月湖北省武汉市协和医院行直视下心脏瓣膜成形术的患者共270例,其中RMT组128例,SMS组142例。观察两组患者术前病史资料、体外循环时间、主动脉阻断时间、总输血量、术后ICU停留时间、术后住院时间、术后并发症,并随访转归情况。结果 RMT组和SMS组患者一般情况具有可比性,均能满意有效地完成瓣膜成形术。两组均有2例院内死亡,在再次开胸、急性肾衰竭、脑血管意外术后并发症发生率方面差异无统计学意义(P>0.05);RMT组在体外循环时间、主动脉阻断时间较SMS组长(P<0.05),而术后ICU停留时间、术后住院时间较SMS组短(P<0.05),总输血量和术后机械通气时间也较少(P<0.05);术后1年随访两组患者在院外死亡率及再手术率方面差异无统计学意义(P>0.05)。结论经RMT行瓣膜成形术安全可行,相对于行SMS术患者具有术后创伤小、恢复快、住院时间短、切口美观等优势,可取得与SMS完全相同的近期手术效果,在无禁忌证的情况下有望成为部分患者瓣膜成形手术中的常规选择。

Objective To evaluate the effects and clinical outcomes of right minithoracotomy （RMT） and standard median sternotomy （SMS） for mitral valve and tricuspid valve repair. Methods 270 patients who underwent RMT （n=128） or SMS （n=142） in mitrai valve repair and tricuspid valve repair from May 2011 to October 2014 in Wuhan Union Hospital were enrolled in this retrospective non-randomized control study. The main outcomes such as general situation of operation, postoperative complications and follow-up results were compared. Results The preoperative characteristics were comparable between these two groups and all the surgeries were completed successfully. There were no statistical differences in mortality （2 dead cases in each group for tricuspid valve repair）, reoperation of bleeding, acute renal failure and neurological events （allP〉0.05）. The extracorporeal circulation time and aortic clamping in RMT group were longer compared with the SMS group （P〈0.05）, but ICU stay, postoperative hospitalization time in the RMT group were shorter than those in the SMS group （P〈0.05）. The SMS group witnessed more blood loss and postoperative mechanical ventilation time （P〈0.05）. Furthermore, there were no significant differences in the 1-year survival rate and freedom from operation rate （P〉0.05）. Conclusion Compared with SMS, RMT in the cardiac valve repair demonstrates the same safety, feasibility, efficiency and early outcomes, with fewer hospitalization time, more rapid recovery and good cosmetic results, which is expected to be a routine altemative for some patients.