右胸前外侧小切口与胸骨上段小切口在主动脉瓣置换术中的短期疗效比较

Short⁃term efficacy of right mini⁃thoracotomy vs.partial upper sternotomy in aortic valve replacement

目的探讨右胸前外侧小切口(right mini⁃thoracotomy,RMT)与胸骨上段切口(partial upper sternotomy,PUS)手术方法在主动脉瓣置换术(aortic valve replacement,AVR)中的应用及短期临床疗效。方法采用回顾性分析法纳入2017年8月至2021年6月在华中科技大学同济医学院附属协和医院行直视下RMT及PUS行主动脉瓣置换术的患者总共240例,其中RMT 120例,PUS 120例。观察两组患者术前病史资料、术中情况、术后并发症和短期的随访情况。结果两组患者术前一般特征具有可比性,且均能成功有效完成瓣膜手术。RMT组术中体外循环时间(P=0.02)、主动脉阻断时间偏长(P=0.03),但总输血量(P=0.02)、术后ICU停留时间(P=0.02)、术后住院时间(P=0.04)、术后并发症等短期预后指标均明显好于PUS组。术后近期随访,两组生存率及重大并发症发生率方面差异无统计学意义(P>0.05)。结论经右胸小切口行主动脉瓣置换术安全可行,可结合胸腔镜辅助,相对于胸骨上段切口患者具有术后创伤小、恢复快、住院时间短、切口美观等优势,可取得与胸骨上段切口完全相同的近期手术效果,在无禁忌证的情况下有望成为部分患者主动脉瓣置换手术中的常规选择。

Objective To explore the short⁃term clinical effect of the two approaches:right mini⁃thoracot⁃omy(RMT)and partial upper sternotomy(PUS)in aortic valve replacement(AVR)comparatively.Methods A total of 240 patients who underwent aortic valve replacement with RMT(n=120)and PUS(n=120)from August 2017 to June 2021 in Union Hospital were enrolled in the retrospective analysis.The preoperative history,general situation of operation,postoperative complications and follow⁃up results were compared between the two groups.Results The preoperative baseline characteristics of the two groups were comparable,and all valvular surgeries were completed successfully and effectively.The cardiopulmonary bypass time(P=0.02)and aortic cross⁃clamping time(P=0.03)in the RMT group were longer than those in the PUS group,but the total value of blood transfusion was significantly smaller(P=0.02),the ICU stay and postoperative hospitalization were both significantly shorter(P=0.02,P=0.04),and the rate of postoperative complications was significantly smaller than those in PUS group.The short⁃term follow⁃up showed no significant difference in the survival rate and the rate of major complications between the two groups(P>0.05).Conclusion Aortic valve replacement through RMT is safe and feasible,which can be combined with video⁃assisted thoracoscopy.Compared with PUS,RMT has the advantages of less trauma,rapider recovery,shorter postoperative hospital stay and better cosmetic results.The short⁃term effect of RMT is exactly the same as that of PUS,thus it is expected to become a routine choice for some patients undergoing aortic valve replacement in case of no contraindications.