胸骨上段正中直切口微创主动脉瓣置换临床分析

Clinical analysis of minimal invasive aortic valve replacement through median straight incision of upper sternum

目的总结经胸骨上段正中直切口微创下实施主动脉瓣置换术的手术经验,为临床提供参考。方法回顾性分析河南省人民医院2019年2月1日至2020年12月31日心外科收治的主动脉瓣行置换术的患者28例的临床资料。患者均予常规单腔支气管插管,全身麻醉下择期行胸骨上段正中直切口微创下主动脉瓣置换术,术中行体外循环。手术过程中观察患者的生命体征,记录体外循环时间、升主动脉阻断时间、手术时间、呼吸机使用时间、重症监护病房(intensive care unit,ICU)停留时间、术后住院时间、输血率、术后引流量、胸管拔除时间。对患者进行术后随访,观察记录患者的预后和并发症的发生情况,并与28例传统正中开胸主动脉瓣置换患者资料作匹配对比性研究。结果28例患者的手术均顺利完成,所有患者均未出现二次转机、主动脉损伤、中转常规开胸。两组患者体外循环时间[(138.5±24.2)min vs.(146.3±29.5)min,P>0.05]、升主动脉阻断时间[(91.1±23.5)min vs.(102.6±29.1)min,P>0.05]、手术时间[(259.9±35.1)min vs.(285.7±44.9)min,P>0.05],呼吸机使用时间[(10.5±3.5)h vs.(12.4±3.3)h,P>0.05]比较,差异无统计学意义。微创手术患者ICU停留时间[(1.6±0.9)d vs.(3.1±1.1)d,P<0.05]、术后住院时间[(10.5±3.3)d vs.(13.8±5.6)d,P<0.05]、输血率(32.2%vs.87.1%,P<0.05)、术后引流量[(348.9±55.9)mL vs.(538.5±84.8)mL,P<0.05]、胸管拔除时间[(2.49±0.7)d vs.(4.0±1.4)d,P<0.05]比传统正中开胸患者明显减少,差异有统计学意义。结论胸骨上段正中直切口微创主动脉瓣置换创伤小、术后恢复快,是治疗主动脉瓣疾病的安全选择。

Objectives To summarize the experience of minimally invasive aortic valve replacement through the median straight incision of the upper sternum,and to provide reference for clinical practice.Methods Totally 28 patients with aortic valve replacement from February 1,2019 to December 31,2020 in Henan Provincial People′s Hospital were analyzed retrospectively. Under the general anesthesia of signal lumen endotracheal intubation,the patients were selected to undergo the minimally invasive lower aortic valve replacement through the median straight incision of the upper part of the sternum under the general anesthesia,and the cardiopulmonary bypass(CPB)was performed during the operation. During the operation,the vital signs of the patients were observed,the CPB duration,ascending aorta blocking duration,operation duration,ventilator use duration,intensive care unit(ICU)stay duration,postoperative hospital stay duration,blood transfusion rate,postoperative drainage volume and chest tube extubation duration were recorded.The patients were followed up and the prognosis and complications of the patients were observed and recorded. The data of28 patients with traditional median aortic valve replacement were compared with those of the patients underwent minimal invasive aortic valve replacement through median incision of upper sternum.Results was successfully completed,and there were no cases of secondary CPB,aortic injury and conversion to conventional thoracotomy. There were no significant differences of the CPB duration[(138.5±24.2)min vs.(146.3±29.5)min,P>0.05],ascending aorta crossing duration[(91.1±23.5)min vs.(102.6±29.1)min,P>0.05],operation duration[(259.9±35.1)min vs.(285.7±44.9)min,P>0.05]and ventilator use duration[(10.5±3.5)h vs.(12.4±3.3)h,P>0.05]between the two groups. ICU stay duration[(1.6 ± 0.9)d vs.(3.1 ± 1.1)d,P<0.05],the postprocedural hospital stay duration[(10.5±3.3)d vs.(13.8±5.6)d,P<0.05],blood transfusion rate(32.2% vs. 87.1%,P<0.05),postoperative drainage volume[(348.9±55.9)m L vs.(538.5±84.8)mL,P<0.05]and chest tube extubation duration[(2.49±0.7)d vs.(4.0±1.4)d,P<0.05]were significantly lower in patients underwent minimally invasive operation than in patients underwent traditional operation.Conclusions of upper sternum is a safe choice for the treatment of aortic valve disease.