3D胸腔镜在再次二尖瓣/三尖瓣手术中的应用

Application of 3D thoracoscopy in cardiac reoperation about mitral/tricuspid valve

目的分析3D胸腔镜在再次心脏手术中的应用情况,总结手术技巧与经验。方法2015年4月至2018年5月,郑州市第七人民医院胸腔镜下再次二尖瓣/三尖瓣手术29例,为腔镜组;回顾2010年1月至2015年1月郑州市第七人民医院常规再次心脏手术患者资料,适合胸腔镜下手术但行常规手术51例,为常规组。结果①两组手术时间(198.42±46.51 VS 316.51±126.81,t=8.92,P<0.01)、体外循环时间(125.86±62.92 VS 193.13±84.47,t=5.93,P<0.01)、呼吸机辅助呼吸时间(15.25±6.12 VS 30.46±11.93,t=10.07,P<0.01)、重症监护时间(31.61±21.25 VS 51.43±35.21,t=3.48,P<0.01),3D腔镜组明显短于常规组;引流量(354±112.69 VS 692.28±371.57,t=19.34,P<0.001)和红细胞使用率(4 VS 23,t=8.10,P<0.05)和血小板使用率(1 VS 24,t=16.37,P<0.001),3D腔镜组显著少于常规组;围术期疼痛评分,3D腔镜组显著低于常规组(3.05±0.69 VS 6.28±1.57,t=7.16,P<0.001);围术期死亡率和并发症发生率无显著区别。②3D胸腔镜再次二尖瓣/三尖瓣手术,1年后生活质量和心脏功能较常规手术无显著区别。结论再次心脏手术中,3D胸腔镜是具有微创、安全、可行的特点,值得开展胸腔镜心脏手术单位临床推广。

Objective To summarize the surgical skills and experience of 3D thoracoscopy in reoperationof heart.Methods 29 patients undergone 3D thoracoscopic mitral/tricuspid valve reoperation fromApril 2015 toMay 2018 were as the endoscopic group.The data of 51 patients who underwent traditional mitral/tricuspid valverecoperation open-hcart surgery from January 2010 to January 2015 were as the conventional group,which couldhave been treated with 3D thoracoscopic surgery.Results(1)The duration of operation[(198.42±46.51)min vs.(316.51±126.81)min,t=8.92,P<0.01],extracorporcal circulation[(125.86162.92)min vs.(193.13184.47)min.t=5.93,P<0.01],ventilator assisted breathing[(15.25±6.12)h vs.(30.46±11.93)h,t=10.07,P<0.01]andintensive care[(31.61±21.25)h vs.(51.43=35.21)h.=3.48.P<0.01]in the two groups were significantly shorterin the endoscopy group than those in the conventional group.The drainage volume[(354.00±112.69)ml vs.(692.28±371.57)ml,I=19.34,P<0.001]and utilization rate of red blood cells(4 vs.23.t=8.10,P<0.05)andplatelet count(1 vs.24,t=16.37,P<0.001)were significantly lower in the endoscopy group than those in theconventional group.Perioperative pain score in the endoscopy group was significantly lower than that in theconventional group(3.05±0.69 vs.6.28±1.57,t=7.16.P<0.001).There was no significant difference inperioperative mortality and complication rate between the 2 groups.(2 There was no significant difference in thequality of lifc and cardiac function l year after the reoperaion between the 2 groups.Conclusion 3Dthoracoscopic in cardiac reoperation is a feasible,safe and minimal invasive approach,so it is worthy of clinicalpromotion.