经右胸小切口入路治疗左心瓣膜术后三尖瓣关闭不全临床效果的单中心回顾性研究

Clinical effect of right minithoracotomy approach on tricuspid regurgitation after the left-sided valve surgery:A retrospective study of a single center

目的分析经右胸小切口入路治疗左心瓣膜术(left-sided valve surgery,LSVS)后三尖瓣关闭不全患者的临床效果。方法回顾性分析2012—2019年在河南省人民医院心脏中心因LSVS后继发三尖瓣关闭不全接受外科手术治疗77例患者的临床资料,根据手术方式将其分为:右胸小切口组32例,男13例(40.6%),年龄(57.3±5.3)岁;胸骨正中切口组45例,男17例(37.8%),年龄(55.7±6.6)岁。对比分析两组患者术前及术后临床资料。结果两组患者术前资料差异无统计学意义(P>0.05)。右胸小切口组三尖瓣成形术24例、三尖瓣置换术8例;胸骨正中切口组三尖瓣成形术29例、三尖瓣置换术16例。与胸骨正中切口组相比,右胸小切口组手术时间、术后住院时间、呼吸机辅助时间、重症监护室监护时间短(P<0.001),术中出血量、术后24 h引流量、术后输血率及术后切口愈合不良发生率少于或低于胸骨正中切口组(P<0.05);两组之间体外循环时间差异无统计学意义(P=0.382);右胸小切口组术后并发症发生率及死亡率低于胸骨正中切口组(P<0.05)。结论与胸骨正中切口入路相比,右胸小切口手术入路可以显著降低围术期并发生症发生率和死亡率,手术安全性好。

Objective To analyze the clinical efficacy of right minithoracotomy approach in the treatment of patients with regurgitation after left-sided valve surgery(LSVS).Methods The clinical data of 77 patients who suffered tricuspid regurgitation(TR)after LSVS and received surgical treatment in the Heart Center of Henan Provincial People's Hospital from 2012 to 2019 were selected.According to the operation method,the patients were divided into a right minithoracotomy group(n=32),including 13(40.6%)males,aged 57.3±5.3 years and a median sternotomy group(n=45),including 17(37.8%)males,aged 55.7±6.6 years.Preoperative and postoperative clinical data of the two groups were compared and analyzed.Results There was no significant difference in preoperative data between the two groups.There were 24 patients of tricuspid valvuloplasty(TVP)and 8 patients of tricuspid valve replacement(TVR)in the right minithoracotomy group.There were 29 patients of TVP and 16 patients of TVR in the median sternotomy group.The operation time,postoperative hospitalization time,intubation time and ICU stay time of the right minithoracotomy group were shorter than those of the median sternotomy group(P<0.001).The operative bleeding,postoperative drainage in 24 hours,postoperative blood transfusion rate and incision poor healing of the right minithoracotomy group were significantly decreased compared with those of the median sternotomy group(P<0.05).The extracorporeal circulation time between the two groups was not significantly different(P=0.382).The postoperative complications and mortality of the righ minithoracotomy group were significantly lower than those of the median sternotomy group(P<0.05).Conclusion The procedure of right minithoracotomy access can reduce perioperative morbidity and mortality compared with the median sternotomy,and results in satisfied clinical efficacy.