胸腔镜辅助右胸微小切口二尖瓣置换术临床分析

Video-assisted Minimally InvasiveMitral ValveReplacement Through Right Minithoracotomy

目的回顾分析胸腔镜辅助右胸微小切口二尖瓣置换术的资料,探讨该术式的临床疗效.方法收集2013年1月至2015年12月66例患者行胸腔镜辅助右胸微小切口二尖瓣置换术,采用穿刺股动脉、股静脉插管建立外周体外循环,Chitwood钳经胸阻闭升主动脉,顺行灌注保护心肌,经房间隔或房间沟入路,胸腔镜辅助下完成二尖瓣置换术.同期由相同手术组完成75例传统正中开胸,上下腔静脉插管,由房间隔入路完成单纯二尖瓣置换术作为对照组.结果全组无死亡,微创组有2例胸腔严重粘连中转开胸行瓣膜置换术.与正中开胸组比较主动脉阻断时间、转流时间、手术时间延长;胸腔引流液、输血减少,差异具有统计学意义(P<0.05).结论胸腔镜辅助右胸微小切口二尖瓣置换术安全,临床疗效等同甚至优于传统正中开胸手术.

Objective To evaluate the feasibility and safety of minimally mitral valve replacement through video-assisted fight mini-thoracotomy. Methods From January 2013 to December 2015, we selected a total of 66 patients underwent video-assisted minimally invasive mitral valve replacement through fight minithoracotomy. The preferred approach for the fight mini-thoracotomy mitral valve surgery for these patients was through 4th interspace mini-thoracotomy incision. Perfusion was accomplished with femoral aortic cannulation, and transthoracic aortic cross-clamp （Chitwood clamp） , cardioplegia needle placement direct ascent aortic, if necessary we used vacuum-assisted venous drainage. Results There were no mortalities and no severe complications in this group. Two patients were converted to full sternotomy because of pulmonary adhesions . Patients were discharged from the hospital 4 to 6 days after the operation. The cardiopulmonary bypass and aortic cross clamp times, the operation time were longer in the minimally invasive group than the traditional operation group, but the volumes of the chest drainage and blood tansfusion were reduced. Conclusion Video-assisted minimally invasive mitral valve replacement through fight minithoracotomy is safe and effective and can be used as an ideal option for mitral valve replacement.