胸腔镜手术与正中开胸二尖瓣成形术治疗二尖瓣反流的效果比较

Effect of thoracoscopic surgery and median sternotomy for mitral valvuloplasty in the treatment of mitral regurgitation:a comparative study

目的 比较胸腔镜手术与正中开胸二尖瓣成形术治疗二尖瓣反流的效果。方法 回顾性分析行二尖瓣成形术的65例二尖瓣反流患者的临床资料,根据手术方式将患者分为胸腔镜组(n=30)和正中开胸组(n=35)。比较两组患者的手术情况及围术期心肺功能指标、住院费用,以及术后2年的并发症发生情况、生存情况、心功能变化情况。结果 (1)胸腔镜组的手术时间、体外循环时间、主动脉阻断时间均长于正中开胸组,关胸时间短于正中开胸组,红细胞、新鲜冰冻血浆、人血白蛋白输注量及血液制品输注总量均少于正中开胸组(均P<0.05),但两组患者的开放辅助时间、二次阻断率、二次开胸止血率、机械通气时间、ICU停留时间、总住院时间比较,差异均无统计学意义(均P>0.05)。(2)术后2周,两组的左室射血分数(LVEF)、左心房内径(LAD)、左心室舒张末期内径(LVED)、第1秒用力呼气容积(FEV_(1))比较,差异均无统计学意义(均P>0.05),但两组的LAD、LVED、FEV_(1)均小于术前(均P<0.05),两组的LVEF与术前差异无统计学意义(P>0.05);两组的用力肺活量(FVC)均较术前下降且正中开胸组低于胸腔镜组(均P<0.05)。两组术后均无二尖瓣中度、重度反流,两组二尖瓣反流情况差异无统计学意义(P>0.05)。(3)两组患者的死亡率、呼吸道感染率、伤口愈合不良率、心律失常率、住院费用,以及术前、术后1年、术后2年的心功能分级比较,差异均无统计学意义(均P>0.05)。结论 采用胸腔镜手术治疗二尖瓣反流患者的疗效和安全性与正中开胸二尖瓣成形术相当,可缩短关胸时间,减少血液制品消耗,减轻患者的经济负担,且不增加术后并发症的发生率,社会效益良好,值得推广应用。

Objective To compare the effect of thoracoscopic surgery and median sternotomy for mitral valvuloplasty in the treatment of mitral regurgitation.Methods Retrospective analysis was made on the clinical data of 65 patients with mitral regurgitation who underwent mitral valvuloplasty.And the patients were divided into thoracoscope group(n=30) and median sternotomy group(n=35),according to the operation methods.The operation conditions,perioperative cardiopulmonary function indexes,hospitalization expenses,as well as 2-year postoperative complications,survival,and cardiac function changes were compared between the two groups.Results(1) The operation time,extracorporeal circulation time and aortic cross-clamping time in the thoracoscope group were longer than those in the median sternotomy group,while the chest closure time,the transfusion volume of red blood cells,fresh frozen plasma,human serum albumin,and the total transfusion volume of blood products were shorter or less in the thoracoscope group than in the median sternotomy group(all P0.05).(2) Two weeks after operation,there was no significant difference in the left ventricular ejection fraction(LVEF),left atrial diameter(LAD),left ventricular end-diastolic diameter(LVED) and forced expiratory volume in one second(FEV_(1)) between the two groups(all P>0.05).However,LAD,LVED and FEV_(1) of the two groups were all lower than those before operation(all P0.05).Compared with the preoperative indexes,the forced vital capacity(FVC) decreased in both groups and was lower in the median sternotomy group than in the thoracoscope group(all P0.05).(3) The mortality rate,respiratory infection rate,poor wound healing rate,arrhythmia rate,hospitalization expenses,and cardiac function grades at 1 and 2 years after operation between the two groups showed no significant difference(all P>0.05).Conclusion The efficacy and safety of thoracoscopic surgery in patients with mitral regurgitation is equivalent to that of median sternotomy for mitral valvuloplasty,which can shorten the chest closure time,reduce the consumption of blood products,release the financial burden of patients,without increasing the incidence of postoperative complications.It has good social benefits and is worthy of popularization and application.