全胸腔镜下Loop技术治疗二尖瓣脱垂

Totally endoscopic mitral valve repair with Loop technique

目的探讨全胸腔镜下Loop技术在治疗二尖瓣脱垂中的临床效果.方法选取2014年10月至2018年10月在武汉亚洲心脏病医院和北大医疗株洲恺德心血管病医院,用全胸腔镜下Loop技术进行治疗27例二尖瓣脱垂患者.根据患者术前计算机断层扫描(CT)测量值,预制人工腱索,全胸腔镜下置入人工腱索并行以心包条环缩二尖瓣手术.记录患者使用腱索数,腱索长度,主动脉阻断时间,转机时间和手术时间等手术参数.观察患者治疗前后左心室直径,左心房直径和心脏血液返流等指标情况,此外监测血栓栓塞,感染性心内膜炎并发症总发生率情况.计量资料以均值±标准差(Mean±SD)表示,采用双尾t检验;计数资料以率表示,采用x^2检验.结果治疗后所有患者均无手术死亡,无再次手术,无重要脏器并发症患者全胸腔镜下Loop技术治疗后,左心室直径和左心房直径明显低于术前[(5.01 ±0.21) cm比(6.17 ±0.16)cm,t=10.100,P<0.01;(3.91±0.21)cm比(6.17±0.16) cm,t=6.382,P<0.01].手术即刻进行经食管超声心动图(TEE)检查,所有患者均为轻微返流或无返流的发生,3个月随访,只有3例患者为中度返流,其余24例均返流程度均在轻度以下.而术后血栓栓塞,感染性心内膜炎并发症发生为0例(0.00%),总发生率明显低于手术前的7例(25.93%),差异有统计学意义(x^2=8.043,P<0.05).结论胸腔镜下能够更好的显露二尖瓣和乳头肌,全胸腔镜下Loop技术治疗二尖瓣脱垂疗效更加显著的疗效.

Objective To investigate the clinical effect of totally thoracoscopic Loop technique in the treatment of mitral valve prolapse. MethodsFrom October 2014 to October 2018, 27 patients with mitral valve prolapse in Wuhan Asia Heart Hospital and PKU care Zhuzhou Kind Cardiovascular Disease Hospital were treated with totally thoracoscopic Loop technique (n=27). According to the preoperative computed tomography (CT) measurements of the patients, the artificial chordae tendineae were prefabricated, and the artificial chordae tendineae were placed under the total thoracoscopy and the pericardial annulus was used to shrink the mitral valve. The number of chordae tendineae used, the length of chordae tendineae, aorta occlusion time, transit time and operation time were recorded. The left ventricle diameter, left atrium diameter and cardiac blood reflux before and after treatment were observed. In addition, the overall incidence of complications from thromboembolism and infective endocarditis was monitored. ResultsAfter treatment, all patients had no operative deaths, no reoperation, and no important organ complications. After total thoracoscopic Loop technique, the indexes of left ventricular diameter (5.01±0.21) cm and left atrial diameter (3.91±0.21) cm were significantly lower than those before surgery LV (6.17±0.16) cm, LA (5.33±0.18) cm, with significant statistical significance (t=10.100, P<0.01). Transesophageal echocardiography (TEE) examination was performed immediately after surgery. All the cases had mild reflux or no reflux. No postoperative thromboembolism and complications of infective endocarditis occurred, and the overall incidence was significantly lower than that of 7 cases (25.93%) before surgery (χ^2=8.043, P<0.05). ConclusionThoracoscopy can better expose the mitral valve and papillary muscle, and totally thoracoscopy Loop technique is more effective in the treatment of mitral valve prolapse.