胸腔镜在再次房室瓣手术中的应用及优势

The application and advantages of thracoscopic operation in reoperative valve surgery

目的探讨胸腔镜下不停跳技术在再次房室瓣心脏手术中应用的优势。方法我院2008年1月至2016年12月行再次房室瓣心脏手术患者中,有51例行胸腔镜下房室瓣手术(T组),通过对手术方式匹配,采用随机数表法从传统胸骨正中开胸患者中选取51例作为对照组(C组),比较两组间各项指标差异及临床预后。结果与C组比较,T组患者手术时间短[(5.04±1.39)h vs.(3.33±1.33)h]、术中出血及输血少[出血(429.22±497.89)mL vs.(203.92±92.65)mL,输血(3.46±4.20)U vs.(0.70±1.52)U]、术后住院时间更短[13(8,21)d vs.9(6,15)d],而体外循环时间、术后ICU停留时间、术后并发症、死亡率及各项生物化学指标等在两组间无明显差异。结论胸腔镜下微创心脏再次房室瓣手术能够规避传统正中开胸手术的风险,优势明显,缩短了手术时间和术后住院时间,减少了术中出血和输血。

Objective To study advantages of thoracoscope surgery over conventional median sternotomy surgery in reoperative valve surgery.Methods From 2008/1 to 2016/12,there were 51 patients who performed redo valve surgery through thoracoscope surgery(Group T)or conventional median sternotomy(Group C),respectively.Results Compared to Group C,Group T had shorter operative time,less bleeding and blood transfusion during surgery,and shorter postoperative hospital stay time.However,the cardiopulmonary bypass time,ICU stay time,complications,in-hospital deaths,and biochemical analysis in two groups showed no significant difference.Conclusion Thus,reoperative valve surgery through thoracoscope can avoid some risk of conventional median sternotomy surgery,and has more ascendancy.