3D胸腔镜技术在二尖瓣手术中的应用

The application of 3D thoracoscope technology in mitral valve surgery

目的总结同期3D胸腔镜下二尖瓣手术和常规开胸二尖瓣手术的临床经验,探讨3D胸腔镜在二尖瓣手术中的应用。方法对比分析郑州市第七人民医院心脏外科2014年1月至2016年12月期间所有接受3D胸腔镜技术治疗(n=35)和常规开胸手术治疗(n=127)的二尖瓣病变患者临床资料,35例3D胸腔镜患者中男12例、女23例,年龄12~54(21.2±19.5)岁;体重32.2~76.5(40.3±16.4)kg。其中二尖瓣狭窄13例,二尖瓣关闭不全7例,二尖瓣狭窄并关闭不全15例,术前心功能Ⅱ级21例,Ⅲ级14例。均采用胸壁3孔入路,建立外周体外循环,阻断升主动脉,顺灌冷心脏停搏液行心肌保护完成手术。常规组患者总计127例,男53例、女74例,年龄32~66(47.2±14.6)岁,体重36.2~80.7(65.3±17.9)kg。其中二尖瓣狭窄42例,二尖瓣关闭不全23例,二尖瓣狭窄并关闭不全62例,术前心功能Ⅱ级73例,Ⅲ级54例。均采用正中开胸建立体外循环,阻断升主动脉,顺灌冷心脏停搏液行心肌保护完成手术。结果 35例患者术后早期无死亡(30天内),手术并发症2.9%(1/35)。对比常规组体外循环时间、主动脉阻断时间、手术操作时间、体外循环预充量、术后呼吸机辅助时间、并发症发生率、病死率没有明显差异(P>0.05),术后ICU滞留时间、围术期引流量、红细胞输注率、住院时间有明显差异(P<0.05)。存活患者术后随访6~38(10.5±12.7)个月,无明显瓣膜返流及瓣膜功能障碍,心功能I~Ⅱ级。结论 3D胸腔镜技术在二尖瓣手术微创外科治疗中安全可靠,对机体创伤小、恢复快,美容效果好,临床前景广阔。

Objective To summarize clinical experience of mitral valve surgery under thoracoscope and conventional thoracotomy mitral valve surgery in the same period and to discuss the application of 3 D thoracoscope in mitral valve surgery. Methods Cardiac surgical cases between January 2014 and December 2016 were retrospectively analyzed in our hospital. A total of 35 patients with mitral valve disease underwent treatment of 3 D thoracoscope technology during the period including 23 male and 12 female,aged 12-54（ 21.2±19.5） years and weighed 32.2-76.5（ 40.3±16.4） kg. 13 patients had mitral stenosis,7 cases with mitral insufficiency,15 cases with mitral stenosis and insufficiency. The preoperative heart function of 21 cases was under class Ⅱ while 14 cases under class Ⅲ.A total of 127 patients underwent conventional surgery,including 53 male and 74 female aged 32-66（ 47.2±14.6） years with the body weight of 36.2-80.7（ 65.3±17.9） kg. Mitral stenosis was seen in 42 cases,mitral insufficiency in 23 cases and 62 cases of mitral stenosis and insufficiency. 73 patients＇ preoperative heart function was under class II while 54 cases under class Ⅲ. Results No early postoperative death（ within 30 days） occurred in thoracoscopic group. Surgical complications were seen in 2.9%（ 1/35） of patients.Compared with conventional group,no significant difference was found in extracorporeal circulation time,aorta cross-clamping time,operation duration,postoperative complications and mortality（ P 0.05）. Postoperative ICU stay time,drainage volume,red blood cell transfusion,length of hospital stay showed significant difference（ P 0.05）. Patients were followed up for 6-38（ 10.5± 12.7） months when no residual shunt and valvular regurgitation was noted and their cardiac function was class Ⅰ-Ⅱ. Conclusions 3 D thoracoscope technology is a safe and reliable minimally invasive option in mitral valve surgery with rapid recovery and good cosmetic effect.