微创小切口与传统开胸二尖瓣手术结果的单中心回顾

Single-center experience of minimally invasive and conventional mitral valve surgery

目的研究回顾右前外侧胸腔切开与常规全胸骨切开二尖瓣手术的结果和经验。方法本院从2018年2月到2019年1月,41例患者通过微创(右前外侧胸腔切开)方法行二尖瓣手术(A组),同期45例患者通过常规胸骨切开术行二尖瓣手术(B组)。将患者的资料进行比较研究。结果两组患者均无死亡、无伤口感染、中风、肾功能衰竭等并发症。术后机械通气时间、ICU时间、二次开胸止血均相似,无统计学差异。术后心律失常、肺部并发症无统计学差异。术中A组患者的主动脉阻断时间、心肺转流时间及手术时间明显长[(75.24±3.08)min vs.(50.00±2.70)min、(113.66±4.01)min vs.(84.47±4.13)min及(238.59±10.15)min vs.(191.00±5.23)min],均(P<0.01)。A组患者切口小[(8.37±0.15)cm vs.(15.07±0.20)cm](P<0.01),术后失血量少[(181.37±16.12)ml vs.(361.00±25.55)ml](P<0.01),输血量少[(0.37±0.15)U vs.(1.00±0.21)U](P<0.05)。A组手术后伤口疼痛需要药物干预发生率低(24.39%vs.57.78%)(P<0.01)。结论经右前外侧第四肋间切口行二尖瓣置换术具有美容效果好、手术创伤小、术后疼痛小等优点,它是一种可行安全的替代传统全胸骨切开二尖瓣置换或成形的方法。

Objective To review the result and experience of mitral valve replacement through right anterolateral thoracotomy approach and median sternotomy approach in our hospital.Methods From February 2018 to January 2019,a total of 86 patients who underwent mitral valve replacement were collected and divided into two groups(group A:right anterolateral thoracotomy approach n=41,group B:median sternotomy approach n=45).The clinical variables were analyzed retrospectively.Results All cases survived without severe complications(incision infection,stroke and renal insufficiency).No significant differences were observed in duration of post-operative mechanical ventilation,ICU stay and reoperation rate between the two groups.There was no statistical difference in the incidence of arrhythmia and pulmonary complications between the two groups.The aortic cross-clamp time,CPB time,operative dura⁃tion were markedly elongated in group A(75.24±3.08 vs.50.00±2.70 min,113.66±4.01 vs.84.47±4.13 min,238.59±10.15 vs.191.00±5.23 min,P<0.01).Compared to group B,the length of incision(8.37±0.15 vs.15.07±0.20 cm,P<0.01),the amount of blood loss(181.37±16.12 vs.361.00±25.55 ml,P<0.01)and blood transfusion(0.37±0.15 vs.1.00±0.21U,P<0.05)were more satisfactory in group A.In addition,the analgesic intensity was lower in group A(24.39%vs.57.78%,P<0.01).Conclusion The mitral valve surgery through right anterolateral thoracotomy approach is a cosmetic,minimally invasive,and low-grade algetic alterna⁃tive compared with median sternotomy approach.