右胸前外侧小切口直视下二尖瓣置换术的临床疗效分析

Analysis of the clinical effect of mitral valve replacement under direct vision from right anterior lateral thoracic incision

目的右胸前外侧小切口二尖瓣置换术与胸正中切口二尖瓣置换术的临床疗效比较。方法选择2017年1月—2019年1月本院心脏外科105例行二尖瓣置换术患者作为研究对象,其中观察组(右胸前外侧切口组)45例,对照组(胸正中切口组)60例。比较分析两组患者的一般情况、体外循环时间、手术总时间等围手术期指标及术后并发症和术后随访情况。结果观察组术中切口长度较对照组短(P<0.05);术后住院时间、机械通气时间、入住ICU时间、术后胸腔引流量、疼痛度(NRS数字分级法)要低于对照组(P<0.05);观察组患者体外循环时间、主动脉阻断时间长于对照组且差异具有统计学意义(P<0.05);两组患者均无院内死亡,术后并发症的发生率的比较差异无统计学意义,两组患者术后随访6~12个月,随访结果满意,无瓣周漏等异常情况。结论右胸前外侧小切口二尖瓣置换术安全、美观、术后恢复快,具有较高临床应用价值。

Objective To compare the clinical effects of mitral valve replacement under right anterior lateral thoracotomy and mitral valve replacement under thoracic median incision.Methods 105 patients undergoing mitral valve replacement surgery in the department of cardiac surgery in the first affiliated hospital of Bengbu Medical College from January 2017 to January 2019 were enrolled as study subjects,including 45 cases in the observation group(the right chest minimally invasive incision group)and 60 cases in the control group(median chest incision group).The perioperative indexes including general conditions,extracorporeal circulation time and total operating time,postoperative complications and postoperative follow-up of patients were compared and analyzed.Results The incision length of the observation group was shorter than that of the control group(P<0.05),and the postoperative hospital stay,mechanical ventilation time,ICU stay,postoperative thoracic drainage,and pain(NRS number grading method)were lower than the control group(P<0.05).The cardiopulmonary bypass time and aortic occlusion time of the observation group were longer than those of the control group and were statistically significant(P<0.05).There were no in-hospital deaths in both two groups,and there was no statistical significant difference in the incidence of postoperative complications.Patients in both groups were followed up for 6 to 12 months.The follow-up results were satisfactory.There were no abnormalities such as pervalvular leakage.Conclusions Right thoracic anterior lateral incision mitral valve replacement is safe,beautiful,and recover quickly after surgery,which has high clinical application value.