小切口与传统切口开胸主动脉瓣置换术的病例对照研究

Effect of small incision versus traditional incision thoracotomy for aortic valve replacement: A case control study

目的对比分析小切口与传统切口开胸心脏主动脉瓣置换术的临床疗效。方法纳入2014年5月至2016年6月我院行主动瓣膜置换术患者78例,按手术方式将患者分为小切口组与开胸组,每组各39例。小切口组,男18例、女21例,年龄(56.4±10.8)岁,以小切口方式进行心脏主动脉瓣膜置换;开胸组,男17例、女22例,年龄(57.1±9.7)岁,以传统开胸手术方式进行心脏主动脉瓣膜置换。结果小切口组患者较开胸组体外循环时间和主动脉阻断时间更长(P<0.05),但其术中输血量、术后24 h引流量显著少于开胸组(P<0.05)。术后机械通气辅助时间、术后住院时间显著短于开胸组(P<0.05)。小切口组疼痛评分显著低于开胸组,差异无统计学意义(P<0.05)。两组患者术后6个月并发症发生率差异有统计学意义(P>0.05)。结论与传统开胸心脏手术相比,小切口心脏手术患者效果好且安全,值得在临床推广使用。

Objective To compare the clinical efficacy of small incision with traditional thoractomy for aortic valve replacement. Methods We retrospectively analyzed the clinical data of 78 patients with heart valve replacement in our hospital between May 2014 and June 2016. The patients were divided into a small incision group and an open chest group with 39 patients in each group. In the small incision group, 18 males and 21 females, aged 56.4±10.8 years, underwent cardiac surgery with a small incision. And in the open chest group, 17 males and 22 females, aged 57.1±9.7 years, underwent cardiac surgery by thoracotomy. Results The extracorporeal circulation time, aortic cross clamping time of the small incision group were longer than those of the open chest group （P〈0.05）. But the amount ofintraoperative blood transfusion and postoperative 24 h drainage volume of the small incision group were significantly less than those of the open chest group （P〈0.05）. Postoperative mechanical ventilation time, and postoperative hospitalization time of the small incision group were significantly shorter than those of the open chest group （P〈0.05）. Pain score of the small incision group was significantly lower than that of the open chest group significantly （P〈0.05）. There was no statistical difference in complications rate between the two groups after 6 months （P〉0.05）. Conclusion Compared with traditional open chest cardiac surgery, small incision cardiac surgery is effective and safe, and is worth popularizing in clinic.